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Perineal necrotizing infection
V Artigas1, J Serra, R Calabuig
1Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
Abstract:
Perineal necrotizing infection is a severe disease that ever since its first description by Fournier in 1883 has been referred to by many names prompted by its protean nature in terms of location and suspected etiology. We treated nine patients with PNI. The infection began as a perineal abscess of long evolution (7 days +/- 2 SD) in eight patients. The ninth patient had had an inguinal herniorrhaphy 3 days before. The cultures of the exudates and tissues always yielded aerobic and anaerobic mixed flora of colorectal origin, except in one instance, in which S. aureus and hemolytic streptococcus A were identified. The treatment was medical support and wide surgical debridement of the infected tissues. In six patients a left transverse colostomy was performed. Only one patient died, of septic shock. On the basis of the results in our series and on a review of the literature, it is our opinion that PNI is a mixed bacterial infection that despite its origin, clinical appearance and microbiologic findings, is highly uniform in terms of clinical course and treatment. Therapy is based on radical surgical debridement with excision of all necrotic tissue. The current plethora of terms seems impractical and confusing. We propose a rather comprehensive term perineal necrotizing infection for the sake of clarity.
Insights
Perineal necrotizing infection (PNI) is a severe mixed bacterial disease. Radical surgical debridement of all necrotic tissue is the recommended treatment for PNI.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Microbiology
Background:
- Perineal necrotizing infection (PNI) is a severe condition with varied nomenclature.
- Historically described by Fournier in 1883, its presentation is diverse.
- PNI often originates from a perineal abscess or post-surgical complications.
Purpose of the Study:
- To analyze the clinical course and treatment outcomes of patients with PNI.
- To propose a standardized term for this condition.
- To emphasize the importance of surgical debridement in PNI management.
Main Methods:
- Retrospective case series of nine patients with PNI.
- Analysis of clinical presentation, microbiological findings, and treatment interventions.
- Literature review to support proposed terminology and treatment guidelines.
Main Results:
- PNI typically presented as a long-evolving perineal abscess or post-herniorrhaphy.
- Mixed aerobic and anaerobic bacteria of colorectal origin were common isolates.
- Wide surgical debridement and, in some cases, colostomy were employed.
- Mortality was low (one of nine patients), primarily due to septic shock.
Conclusions:
- PNI is a uniform clinical entity in its course and treatment, despite varied etiology and presentation.
- Radical surgical debridement is the cornerstone of effective PNI therapy.
- The term "perineal necrotizing infection" is proposed for clarity and consistency.