Conservative Surgical Management and Delayed Primary Closure in Fournier's Gangrene of Perianal Origin: A Case Report and Literature Review.

Fournier's gangrene (FG) is a fulminant and life-threatening polymicrobial necrotizing fasciitis of the perineal, perianal, and genital regions. It typically affects patients with significant comorbidities, particularly poorly controlled diabetes mellitus, and is associated with high mortality rates. We describe the case of a 57-year-old male patient who presented with a one-month history of severe perineal pain, initially misdiagnosed as uncomplicated hemorrhoidal disease. Upon admission, the patient exhibited systemic inflammatory response syndrome and a large, purulent perianal mass. The patient underwent an emergency radical surgical debridement followed by three serial surgical washouts and strict glycemic control. Ultimately, successful delayed primary closure was achieved without the need for fecal diversion or complex reconstructive flaps. His postoperative course was favorable, with complete preservation of sphincter function. This report underscores the importance of considering early radical debridement and demonstrates that a staged conservative surgical approach can yield excellent functional and cosmetic outcomes in extensive perineo-scrotal defects.