GENITOPERINEAL GANGRENE - EXPERIENCE IN SINGAPORE

Background: The experience with genitoperineal gangrene at the Departm ent of Colorectal Surgery,Singapore General Hospital is documented. Me thods: The results of 12 patients treated during the 5 year period bet ween 1 January 1990 and 31 January 1995 were studied. There were 10 me n and two women. The mean age of the patients was 55.2 (range 37-83) y ears. Results: Perianal pain and swelling were the commonest presentat ion. However, three patients were admitted in a toxic state with menta l confusion. The gangrene progressed from anorectal sepsis in six pati ents. Five of these patients had diabetes mellitus. Escherichia coli w as the commonest organism cultured. Early diagnosis, immediate resusci tation, antibiotics and early aggressive surgery was our management po licy. Applying these principles, all except two patients survived (mor tality 17%). One had advanced malignacy and the other had extensive bu rn injuries. Conclusions: A high index of suspicion should be maintain ed in patients with diabetes and with anorectal sepsis. Should genitop erineal gangrene develop, aggressive surgery is often successful.