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

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.