A reappraisal of surgical management in necrotizing perineal infections

The proper treatment of necrotizing perineal infections (Fournier's gangrene) remains unclear in the surgical literature. This study reports a technique that emphasizes anatomic considerations in the diagnosis and treatment of these infections together with mandatory use of colostomy in selected cases. Eight cases treated at William Beaumont Hospital from 1977 to 1985 were reviewed. There were five men and three women. All had predisposing local pathology. Recognizing the site of local pathology is the key factor in making correct surgical judgments in these cases. The perineum may be divided into the urogenital triangle and anal triangle by a line passing between the ischial tuberosities. Cases originating in the urogenital triangle were treated with antibiotics and wide surgical debridement. Two cases were successfully managed in this fashion. Cases originating in the anal triangle were treated with mandatory colostomy and mucus fistula with irrigation of the rectal segment together with antibiotics and wide debridement. Six cases were found to have originated in the anal triangle. Four were successfully treated. This anatomic approach and proper use of colostomy represents the correct treatment of these infections.