Pelvic Sepsis. Life-Threatening Infection In The Anorectal Region

The term "pelvis sepsis" describes a destructive and life-threatening process in the perianal and genital areas. The rapidly spreading necrosis is a special form of necrotizing soft tissue infection (NSTI). Most patients initially have perianal or urinary tract infections but trauma or postoperative complications may also be a cause of the disease. In contrast to a localized abscess the infection spreads diffusely along the fascial planes into the whole pelvic region. Due to the rapid progress the infection evolves into a systemic sepsis in the early phase of the illness. The clinical presentation makes a radical debridement of the involved areas necessary. Only prompt surgical intervention can reduce the high mortality of the disease. Most cases are caused by mixed Gram negative, Gram positive and anaerobic flora. Empirical antimicrobial treatment should be started with a broad spectrum antibiotic combination, e.g. piperacillin and tazobactam. Interdisciplinary management is essential and should include critical care physicians and reconstructive plastic surgeons.