title: Necrotising perineal infection: a fatal outcome of ischiorectal fossa abscesses.
abstract: BACKGROUND
  Necrotizing perineal infection or Fournier's gangrene is an uncommon but lethal complication of ischiorectal fossa abscesses. It is associated 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 determined.
  
  
  METHODS
  The medical records of 8 patients who presented with necrotizing perineal infection as a complication of ischiorectal fossa abscesses were reviewed. Various parameters were studied to see if any of them could serve as predictors of outcome. Mean surface area of involvement was calculated using modified burns assessment criteria. To study the effect of colostomy on the general condition of the patient the physiological and biochemical parameters before and after the procedure were compared. Statistical analysis was done using the unpaired and paired 't' tests.
  
  
  RESULTS
  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 with the initial radical debridement, in three other patients it was formed on days three, five and five, respectively. There was a significant improvement in their general status and biological parameters. All patients with testicular involvement died.
  
  
  CONCLUSIONS
  Evidence of systemic sepsis at presentation, extent of tissue and testicular involvement, a low haematocrit, a high blood urea and creatinine and a low serum albumin, were associated with a higher mortality. Prompt recognition of the condition, urgent radical surgical debridement and the use of appropriate antibiotics are the mainstays of management. Formation of a diverting colostomy appears to favour survival.
authors.affiliation: Department of Surgery, Seth G.S. Medical College, Parel, Mumbai, India. moorthyk@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Moorthy
authors.forename: P P
authors.initials: PP
authors.lastname: Rao
authors.forename: A N
authors.initials: AN
authors.lastname: Supe
mesh_terms: D000038:Abscess / Q000150:complications*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D048909:Diabetes Complications; D018934:Fournier Gangrene / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009919:Orchiectomy; D012002:Rectal Diseases / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents