Perineal infection remains as a major source of morbidity and mortality after perineal injuries. It is well known that initial hemorrhage and later sepsis are 2 major causes of death in the patients with deep perineal injuries. Perineal injury
carries
inherent risk of fecal contamination and ensueing perineal infection due to its location in vicinity of the anus.
Unlike colorectal injury, there is no well estabolished idications for proximal diverting colostomy in the patients with perineal injuries. In order to determine the indications for proximal diverting colostomy in prineal injury, we reviewed and
analyzed the factors associated with perineal infection in 32 deep perineal injuries who had treated in the Department of General Surgery, Kyung pook National University Hospital during the period from 1983 to 1992.
Thirty two deep perineal injuries included 21 blunt and 11 penetrating injuries.
Associated injuries were anorectal (53.1%), pelvic bone fracture(43.7%), urologic(17.7%), iliac arterial(6.3%), small bowel rupture(3.1%), spinal cord(3.1%), and head (3.1%), and head(3.1%) injuries. To avoid perineal infection, proximal
diverting
colostomies for 22 and distal colon wash out for 11 patients were performed.
Seventeen patients (53.1%) were accompanied by perineal infections and 5(29.4%) of them developed into generalized sepsis resulting in 2 deaths. Anaslysis with Chi-square test revealed the patients with 1) blunt injury, 2) initial hypovolemic
shock, 3)
pelvic bone fracture, and 4) bed ridden condition for 2 weeks or longer after injury had significantly (p<0.05) higher frequencies of perineal infection. But there revealed no significant differences in the frequencies of perineal infection
between
the
patients groups by the sex, presense of anorectal injury, site of perineal wound, and performances of proximal diverting colostomy, distal colon wash out, or primary closure of perineal wound.
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