| Sumario: | Aim: value of early colostomy creation in cases of badly infected perineal wounds and necrotizing fasciitis cases (commonly seen in immunocompromised status). Method: over the last 2 years (period from February 2014 till March 2016) we had 10 patients with serious badly infected perineal wounds had diversion colostomy to minimize septicaemia, ARDS, renal and other complications. This was reviewed retrospectively versus severe cases which were managed without early colostomy. Double barrel sigmoid colostomy was commonly used in most cases (end colostomy was performed in one case only). Colostomy should be properly placed, well fitted with no leak around to prevent excoriation and soiling of the surrounding skin (pictures included). Results / Discussion: Of cases of severe heavily infected necrotic wounds following incision and drainage of abscesses around the anus and perineal areas we noticed that cases where early colostomy was performed had a much better outcome with rapid healing and less complication. (One of the cases of Fournier's gangrene was following simple haemorrhoidectomy!!). Enriched diet with high protein could be commenced early for these patients to improve their nutritional status with no fear of soiling. Patient and his family should be prepared psychologically for the long-term management plan and repeated surgical intervention before closure colostomy. Conclusion: Early diversion colostomy in cases of severe badly infected perineal wounds and necrotizing fasciitis may have a significant and dramatic effect on prognosis, rapid healing and less complication when it is done in the proper time without hesitancy. Patient should be prepared for a long-term management plan from all medical, surgical, psychological and social aspects.
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