Necrotising perineal infection: a fatal outcome of ischiorectal fossa abscesses

Introduction: Necrotizing perineal infection or Fournier's gangrene is an u ncommon but lethal complication of ischiorectal fossa abscesses. It is asso ciated with a high mortality, especially in diabetics and immunocompromised individuals. Attempts have been made to study factors which could serve as prognostic indicators, The role of faecal diversion has not been clearly d etermined, Materials and methods:The medical records of 8 patients who pres ented with necrotizing perineal infection as a complication of ischiorectal fossa abscesses were reviewed. Various parameters were studied to see if a ny of them could serve as predictors of outcome. Mean surface area of invol vement was calculated using modified burns assessment criteria, To study th e effect of colostomy on the general condition of the patient the physiolog ical and biochemical parameters before and after the procedure were compare d,Statistical analysis was done using the unpaired and paired 't' tests. Re sults: The mean age of the patients was 50.6 +/- 10.3 years. Five patients were diabetic, of whom four died; all the non-diabetics survived. The mean surface area of involvement was 5.1 +/- 0.75%, among the survivors, and 9.6 +/- 3.4% among the non-survivors. Colostomy was performed in four patients one of whom died. While in one patient the colostomy was created along wit h the initial radical debridement, in three other patients it was formed on days three, five and five, respectively. There was a significant improveme nt in their general status and biological parameters. All patients with tes ticular involvement died. Conclusion: Evidence of systemic sepsis at presen tation, extent of tissue and testicular involvement, a low haematocrit, a h igh blood urea and creatinine and a low serum albumin, were associated with a higher mortality. Prompt recognition of the condition, urgent radical su rgical debridement and the use of appropriate antibiotics are the mainstays of management. Formation of a diverting colostomy appears to favour surviv al.