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Introduction and Objectives: Necrotizing perineal infections are rare and potentially devastating in the pediatric population, and little is known about the disease in the newborn period and infancy. While rare, they can be. Management is associated with improved outcomes with early diagnosis. We review, analyze and describe outcomes of necrotizing perineal infections in 3 patients encountered at our hospital.
 
Methods: We report 3 cases with rapidly progressive perineal infections highly suspicious for necrotizing fasciitis of the genitalia and perineum (Fournier’s Gangrene) cared for at a single institution in a 6 year period. Data recorded included medical history, clinical characteristics, diagnostic procedures, treatment methods and outcome.
 
Results: Patients aged 7 months, 8 months and 15 years were treated for necrotizing fasciitis of the perineum and scrotum. Predisposing factors were prior surgery (mid-shaft hypospadias repair and incarcerated inguinal hernia repair) and in one patient, profound neutropenia with no other predisposing factor. Initial skin presentations were induration or cellulitis, and erythema and edema with progression to skin discoloration and bullae formation. Fever and tachycardia were the most common clinical features. All patients underwent operative assessment of the affected area (biopsy in 2) with frozen section analysis demonstrating necrosis. Extensive debridement was necessary in 1 patient. All received appropriate antibiotic and supportive therapy. Antibiotic therapy was guided by culture data. In two patients the only revealing culture data was obtained from deep intraoperative tissue biopsy Gram stain and culture, as systemic cultures were negative. Two patients survived, and 1 patient with profound immunosupression and rapidly progressive necrotizing fasciitis succumbed to septic shock. The 2 survivors improved with antibiotic therapy and supportive care with excellent wound healing.
 
Conclusions: Although necrotizing perineal infections are rare in children, their lethal potential and early diagnostic signs must be recognized. All children should undergo early surgical assessment with tissue biopsy and culture. The mortality and morbidity associated with these infections may be decreased with clinical awareness, early diagnosis, empiric and definitive antibiotic therapy, urgent surgical biopsy and debridement, and intensive supportive care.