Of 9 patients with perineal gangrene secondary to abscess of anal margin, 7 presented deficiency states. Diagnosis was established after an average of 7.4 days following onset of signs, although the clinical picture was obvious and the lesions extended beyond the perineum towards the genital organs, buttocks or thigh. Essential therapy consisted of antibiotic cover, immediate and repeated surgical excision (average number of operations per patient = 6) and stools bypass by colostomy for severe perineal lesions. This resolutely aggressive treatment reduced mortality of this reputedly serious affection to 2 cases (22%), but morbidity was high and a perineoplasty was necessary in a third of the patients.
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