[Perineal gangrene: new bacteriologic approach. Results of medico-surgical treatment (81 cases)]
C Brunet1, B Consentino, A Barthelemy
1Services de chirurgie générale et urgences, département informations médicales, hôpital Sainte-Marguerite, Marseille, France.
Study Objective:
The objective of this retrospective study was to report the results of a series of 81 cases of perineal gangrene treated in the same center.
Patients And Methods:
From 1988 to 1998, 81 patients (64 males, 17 females, mean age: 58 years) with perineal gangrene were treated by a medico-surgical team, by means of a protocol combining appropriate intensive care measures based on a new bacteriologic concept of infectious agents, extensive excisions and drainage of the infraperitoneal region and hyperbaric oxygen therapy.
Results:
The mortality rate was 24.7%. Mean duration of intensive care stay was 19 days, mean duration of hospital stay was 31 +/- 4 days (range: 6 to 60 days). Risk factors were: age > 68 years (p = 0.001), shock (p = 0.83), subcutaneous crepitation (p = 0.25) and severity index > 10 (p = 0.003). Sequelae were anal incontinence (n = 3) and permanent colostomy (n = 5). Secondary plastic reconstruction was necessary in four patients. There were no urologic or genital sequelae.
Conclusion:
Perineal gangrene is still a very serious disease. The time to treatment, the simplified severity index and consideration of bacteriologic combinations are the main prognostic factors.
Insights
Perineal gangrene remains a severe condition. Prompt treatment, a simplified severity index, and understanding bacteriologic combinations are key prognostic factors for improved patient outcomes.
Area of Science:
- Medical research
- Surgical outcomes
- Infectious disease management
Context:
- Perineal gangrene is a rare but life-threatening condition.
- Previous treatment protocols varied, lacking standardized approaches.
- This study evaluates a specific medico-surgical protocol implemented over a decade.
Purpose:
- To report the outcomes of 81 patients treated for perineal gangrene.
- To identify significant risk factors and prognostic indicators.
- To assess the efficacy of a comprehensive treatment protocol.
Summary:
- A retrospective analysis of 81 perineal gangrene cases (1988-1998) treated with intensive care, surgical debridement, and hyperbaric oxygen therapy.
- Mortality rate was 24.7%. Key prognostic factors included age over 68 and a high severity index.
- Sequelae included anal incontinence and need for colostomy; no urologic or genital complications were noted.
Impact:
- Highlights the critical role of timely intervention and accurate prognostication in managing perineal gangrene.
- Provides valuable data for refining treatment strategies and improving patient survival rates.
- Emphasizes the importance of bacteriologic considerations in treatment protocols.
