NECROTIZING SOFT TISSUE INFECTION IN THE PERIANAL REGION: A RETROSPECTIVE STUDY AT HOSPITAL ESTADUAL ALBERTO TORRES

Introduction Necrotizing soft tissue infection (NSTI) is a severe condition that can affect the skin, subcutaneous tissue, fascia, and muscles. It is polymicrobial and rapidly progressive, and if not recognized and treated early, it spreads to adjacent tissues with significant potential for devastation and systemic impact. Other terms used include fasciitis, necrotizing fasciitis, perineal necrosis, and Fournier's syndrome. Despite clinical, diagnostic, and intensive care advances, it carries high morbidity and mortality rates.

Objective To study the characteristics of patients treated for perineal NSTI.

Method A retrospective study conducted from January 2019 to December 2022, involving patients treated for NSTI. Data on age, gender, affected region, comorbidities, signs and symptoms, complementary exams, clinical and surgical treatment, hospitalization duration, and mortality were collected.

Results 31 patients were treated during the study period, ranging in age from 19 to 73 years, with 23 men. The genital-perineal region was the most affected (28), followed by the buttocks and sacral region (2 each). Diabetes mellitus associated with hypertension were the most common comorbidities (14). Overweight was observed in 12 patients. Thirty patients complained of local pain, 24 had fever, and 23 presented swelling and erythema with a mass. Crepitus and discharge with skin necrosis were seen in 24 cases. Leukocytosis above 12,000 was found in 28 patients, and above 20,000 in 13. A CT scan was performed on 20 patients, with 16 showing gas in the region and four showing only local edema. All patients received antibiotics upon admission, with 26 maintaining the same regimen until treatment completion and five requiring changes or additions. Surgical debridement was performed on all patients, with three requiring colostomy. A single debridement was sufficient in 24 cases, two were needed in six, and four in one. Cultures of secretions or tissues were done in 16 patients, with six results negative. The hospitalization period ranged from 5 to 30 days (median 14.5), with 29 patients staying more than a week, and one death was recorded.

Conclusion NSTI constitutes a surgical emergency, with treatment based on early and extensive debridement, antibiotic therapy, and maintenance of a clean surgical wound free from necrotic tissue. Colostomy should only be performed in patients with perineal lesions who are bedridden.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025