18 Hours Of Rapidly in Surgery — 62yo Man | General Surgery | SMLE Q#11360
SMLE Question #11360
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 62-year-old man with poorly controlled type 2 diabetes mellitus and chronic kidney disease presents with 18 hours of rapidly worsening perineal pain and swelling with fever, malaise, and foul-smelling discharge. Examination shows an erythematous, edematous, fluctuant perineal swelling with crepitus and malodorous purulent discharge extending toward the scrotum, with dusky tender skin beyond the obvious necrotic area. What is the most appropriate initial management?
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