title: Nonsurgical faecal diversion in the management of severe perianal sepsis: a retrospective evaluation of the flexible faecal management system.
abstract: BACKGROUND
  Severe perianal sepsis is often difficult to manage after surgical debridement due to faecal contamination. Diversion of the faecal stream has been attempted with faecal pouches and rectal tubes, and in some cases, a diverting stoma is created. However, reversal of the stoma may be delayed due to prolonged sepsis and this is not without risks. Herein, we review the use of a flexible faecal management system in patients with severe perianal sepsis.
  
  
  METHODS
  We retrospectively evaluated 15 patients who made use of the ConvaTec Flexi-Seal® Fecal Management System (FMS) between 1 January 2007 and 31 December 2010. The demographics and comorbidities of the patients, as well as the treatment received, were recorded and reviewed.
  
  
  RESULTS
  None of the patients required the creation of a stoma to divert the faecal stream. Nursing requirements and wound care were found to be improved with the use of the Flexi-Seal® FMS (fewer changes were needed). No severe complications were observed in our series. Two deaths were encountered, but the cause of death was not directly due to the initial perianal sepsis. Overall, the wound healing rate was 80.0%, with one graft failure (11.1%).
  
  
  CONCLUSIONS
  The use of the Flexi-Seal® FMS in patients with perianal sepsis following extensive debridement is feasible and can be considered before stoma creation.
authors: Minghui
authors: M
authors: Goh
authors: Min-Hoe
authors: MH
authors: Chew
authors: Phui-Sze
authors: PS
authors: Au-Yong
authors: Choo-Eng
authors: CE
authors: Ong
authors: Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608. tang.choong.leong@sgh.com.sg.
authors: Choong-Leong
authors: CL
authors: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins / Q000302:isolation & purification; D002408:Catheters, Indwelling; D003646:Debridement; D016983:Enterococcus / Q000302:isolation & purification; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000601:surgery; D005243:Feces; D005260:Female; D018934:Fournier Gangrene / Q000382:microbiology; D006460:Hemolysin Proteins / Q000302:isolation & purification; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000382:microbiology; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D012846:Singapore; D054047:Surgical Stomas; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D006460:Hemolysin Proteins; C071495:streptococcal group B hemolysin
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