Colostomy for Fournier's gangrene with rectum exposure

Fournier's gangrene (FG) can be treated with prompt surgical debridement. Stoma revision has also been performed to prevent fecal contamination. However, recent advances in stool and wound management have reduced the need for colostomy. We report four cases of severe FG with an exposed rectum and discuss the conditions under which colostomy is indispensable. All four peoples developed FG, and an emergency debridement was performed, resulting in exposure of the rectum. Two peoples with perirectal infectious inflammation extending to the anterior rectum underwent colostomy because the inflammation had reached the retroperitoneum, but the other two, where the inflammation was confined to the dorsal-lateral rectum, were treated successfully without colostomy. We believe that colostomy can be avoided by using suitable wound management devices, except in severe cases where soft tissue infection and necrosis extend to the peritoneum and retroperitoneum and there is concern about rectal ischemia. Number of similar cases published: 0.