Diagnostic and Management Strategies for Fournier's Gangrene in the Emergency Department: A Systematic Review

Authors

  • Abdullah Abdulaziz F Alhowidi Emergency Medicine Consultant, Emergency Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia Author
  • Abdullah Muneer Alhamood Medical intern, College of Medicine, Alexandria University, Alexandria , Egypt Author
  • Faisal Abdulrahman Almalki Genral physician, King Fahad Hospital, Jeddah, Saudi Arabia Author
  • Waleed Hisham Alkhalidi Medical intern, Collage of medicine, Majmaah University, Riyadh, Saudi Arabia Author
  • Abdulellah Essam Zamzami Medical intern, College of medicine, King Saud University, Riyadh, Saudi Arabia Author
  • Khalid Mohammed Alzahrani Medical intern, College of medicine, University of Jeddah, Jeddah, Saudi Arabia Author
  • Saad Aldeen Sami Baradah Medical intern, College of medicine, King Abdulaziz university, Jeddah, Saudi Arabia Author
  • Abdullah Ayed Alqurashi Medical Intern, College of Medicine UQU, Makkah, Saudi Arabia Author
  • Mohammed Salah Alkhattabi Medical Intern, College of Medicine UQU, Makkah, Saudi Arabia Author
  • Lama Ayed Alamri Medical Intern, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Author
  • Maysam Hussain Alyami Medical intern, College of medicine, princess Nourah bint Abdulrahman university, Riyadh, Saudi Arabia Author
  • Danah Mohammed Alqahtani Medical intern, College of Medicine, AlMaarefa University, Riyadh, Saudi Arabia Author

DOI:

https://doi.org/10.65759/5ja8z340

Keywords:

Fournier’s gangrene, emergency department, necrotizing soft tissue infection, diagnostic imaging, surgical debridement

Abstract

Background: Fournier’s gangrene is a rapidly progressive infection requiring coordinated emergency diagnosis, resuscitation, antimicrobial treatment, and surgical source control. Early manifestations overlap with less severe perineal infections, creating substantial diagnostic uncertainty. This review examined diagnostic and management evidence relevant to emergency department practice. Methods: Publications available through 31/05/2026 were evaluated using an explicit clinical framework. Eleven original reports addressing imaging, prognostic assessment, surgical timing, antimicrobial duration, hyperbaric oxygen, wound management, and fecal diversion were summarized. Findings were synthesized narratively because study designs, treatment selection, and outcome definitions differed. Results: Computed tomography demonstrated anatomical disease extent, although imaging findings from confirmed cases did not establish diagnostic accuracy in unselected emergency populations. Prognostic scores identified physiological disturbance without replacing clinical assessment or operative diagnosis. Earlier debridement was associated with lower mortality, including mortality of 2.6% versus 27.7% for surgery within versus after twelve hours in one cohort. Shorter antimicrobial courses following source control were not associated with worse outcomes in a retrospective study. Hyperbaric oxygen, negative pressure wound therapy, and fecal diversion produced favorable findings in selected cohorts, with substantial uncertainty from nonrandom treatment allocation. Conclusions: Emergency management prioritizes early surgical involvement, immediate broad spectrum antimicrobials, physiological stabilization, and prompt debridement. Imaging and prognostic tools support decisions without postponing source control. Adjunctive interventions require individualized selection, while prospective comparative research remains essential for defining their benefits.

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Published

2026-10-28

Issue

Vol. 3 No. 04 (2026): Journal of Tazeez for Public Health

Section

Articles