Combined right hemicolectomy and pancreaticoduodenectomy for locally advanced right hemicolon cancer.

Extracolonic invasion of the duodenum and/or pancreatic head rarely occurs in patients with right hemicolon cancer. However, when necessary, combined radical operation is a challenge to the surgeon. We reported 7 patients with locally advanced right hemicolon cancer who underwent combined right hemicolectomy (RH) and pancreaticoduodenectomy (PD) due to direct involvement of the duodenum or pancreatic head. This study included four males and three females with a mean age of 66.9+/-5.9 years. Computed tomography (CT) scans revealed right hemicolon cancer with duodenal invasion (5 patients) and pancreatic invasion (2). The mean operation time was 410+/-64 minutes and the estimated blood loss was 514+/-157 mL. After the operation, the mean postoperative hospital stay was 22.1+/-7.2 days. Five patients had postoperative complications. The mean follow-up time was 16.4+/-5.9 months. During this period, three patients died from tumor recurrence, one from postoperative complications, one from pulmonary disease, and two survived until the last scheduled follow-up. Five patients survived more than one year. Combined RH and PD for locally advanced right hemicolon cancer can be performed safely, thus providing a long-term survival rate in selected patients in a high-volume center.

[Hand-assisted laparoscopic surgery in radical resection of rectal cancer].

OBJECTIVE: To investigate the application experience and clinical effects of hand-assisted laparoscopic radical resection for rectal cancer. METHODS: The clinical data of 156 patients with rectal cancer treated with hand-assisted laparoscopic surgery between August 2009 and April 2011 were analyzed retrospectively. RESULTS: The operative procedures of 156 patients were completed successfully and 1 case was converted to laparotomy (0.6%). The mean operation time was (125 ± 35) minutes; the mean intraoperative blood loss was (118 ± 60) ml; the mean time of bowel function recovery was (60 ± 8) hours; the median postoperative hospital stay was (9.5 ± 2.2) days. The mean number of lymph nodes dissection was (14 ± 5). Five patients (3.2%) had postoperative complications. All the patients were followed up. There had been no local recurrence or trocar site implantation metastasis. CONCLUSION: Hand-assisted laparoscopic surgery approach for the curative resection of rectal cancer is safe and effective and has broad prospects in clinical application.

Inflammatory bowel diseases and hepatitis C virus infection.

BACKGROUND: Data on the prevalence of hepatitis C in patients with inflammatory bowel diseases (IBD) are limited and conflicting. This study was to assess the prevalence of hepatitis C virus (HCV) infection in IBD patients and to define the clinical and immunologic profile of IBD associated with HCV infection. METHODS: Ten patients (seven females and three males) with IBD and HCV infection were consecutively recruited in our department between June 2005 and May 2010. We analyzed the clinical and serologic description of all patients. RESULTS: The mean age of the 10 patients was 41 years and the median disease duration was 7 years. With present and/or past HCV infection, the patients had clinical manifestations and were positive for endoscopic study or histological test. Compared with the HCV-negative IBD group, the HCV-positive IBD group have a higher positive rate of autoantibodies (antinuclear antibodies, antieutrophil cytoplasmic antibody, and anti-SSa/SSb). In the HCV-positive group, 8 patients were positive for p-antieutrophil cytoplasmic antibody, 4 positive for antinuclear antibodies, and 3 positive for anti-SSa/SSb. Four patients had an elevated level of transaminase (alanine transminase, and aspartate transminase). CONCLUSIONS: HCV positive in IBD may induce autoanti-bodies (antinuclear antibodies, antieutrophil cytoplasmic antibody, anti-SSa/SSb) and damage of liver function. In managing IBD patients, physicians should be aware of screening of HCV and prescribe antiviral treatment.

[Significance of K-ras detection in colorectal cancer].

OBJECTIVE: To determine the mutation status of K-ras gene in colorectal cancer and analyze the associations between its mutation status and clinicopathological characteristics in colorectal cancer so as to select the patients likely to benefit from a targeted therapy. METHODS: A total of 208 colorectal cancer tissue samples were collected from September 2008 to February 2009. DNA was extracted with a genomic DNA miniprep kit. Then PCR was performed with the designed primers and the product directly sequenced by the Sanger method. Then the associations between K-ras mutation status and clinicopathological characteristics in colorectal cancer were analyzed. RESULTS: Of 208 cases, 91 cases of K-ras gene mutation were detected. The 12 or 13 codon had a mutation rate of 43.8%. There were no significant differences in gender, tumor location, histopathological grading and Duke's stage between the wild and mutated groups. CONCLUSION: Detection of K-ras gene status in colorectal cancer will help to select the patients likely to benefit from the monoclonal antibody therapy of targeting epidermal growth factor receptor.

Comparison of Gut Microbiome in Human Colorectal Cancer in Paired Tumor and Adjacent Normal Tissues.

BACKGROUND: To understand the biological effect of gut microbiome on the progression of colorectal cancer (CRC), we sequenced the V3-V4 region of the 16S rRNA gene to illustrate the overall structure of microbiota in the CRC patients. METHODS: In this study, a total of 66 CRC patients were dichotomized into different groups based on the following characteristics: paired tumor and adjacent normal tissues, distal and proximal CRC segments, MMR (-) and MMR (+), different TNM staging and clinic tumor staging. RESULTS: By sequencing and comparing the microbial assemblages, our results indicated that 7 microbe genus (Fusobacterium, Faecalibacterium, Akkermansia, Ruminococcus2, Parabacteroides, Streptococcus, and f_Ruminococcaceae) were significantly different between tumor and adjacent normal tissues; and 5 microbe genus (Bacteroides, Fusobacterium, Faecalibacterium, Parabacteroides, and Ruminococcus2) were significantly different between distal and proximal CRC segments; only 2 microbe genus (f_Enterobacteriaceae and Granulicatella) were significantly different between MMR (-) and MMR (+); but there was no significant microbial difference were detected neither in the TNM staging nor in the clinic tumor staging. CONCLUSION: All these findings implied a better understanding of the alteration in the gut microbiome, which may offer new insight into diagnosing and therapying for CRC patients.

Novel blood-based, five-gene biomarker set for the detection of colorectal cancer.

PURPOSE: We applied a unique method to identify genes expressed in whole blood that can serve as biomarkers to detect colorectal cancer (CRC). EXPERIMENTAL DESIGN: Total RNA was isolated from 211 blood samples (110 non-CRC, 101 CRC). Microarray and quantitative real-time PCR were used for biomarker screening and validation, respectively. RESULTS: From a set of 31 RNA samples (16 CRC, 15 controls), we selected 37 genes from analyzed microarray data that differed significantly between CRC samples and controls (P < 0.05). We tested these genes with a second set of 115 samples (58 CRC, 57 controls) using quantitative real-time PCR, validating 17 genes as differentially expressed. Five of these genes were selected for logistic regression analysis, of which two were the most up-regulated (CDA and MGC20553) and three were the most down-regulated (BANK1, BCNP1, and MS4A1) in CRC patients. Logit (P) of the five-gene panel had an area under the curve of 0.88 (95% confidence interval, 0.81-0.94). At a cutoff of logit (P) >+0.5 as disease (high risk), <-0.5 as control (low risk), and in between as an intermediate zone, the five-gene biomarker combination yielded a sensitivity of 94% (47 of 50) and a specificity of 77% (33 of 43). The intermediate zone contained 22 samples. We validated the predictive power of these five genes with a novel third set of 92 samples, correctly identifying 88% (30 of 34) of CRC samples and 64% (27 of 42) of non-CRC samples. The intermediate zone contained 16 samples. CONCLUSION: Our results indicate that the five-gene biomarker panel can be used as a novel blood-based test for CRC.

Application of 4% formaldehyde under electronic colonoscope as a minimally invasive treatment of chronic hemorrhagic radiation proctitis.

BACKGROUND: To investigate the effectiveness of topical application of 4% formaldehyde as a minimally invasive treatment of rectal bleeding due to chronic radiation proctitis (CRP) under direct vision of electronic colonoscope. METHODS: The clinical data of 13 CRP patients complicated with ≥ grade II bleeding admitted to our hospital between January 2003 and December 2018 were retrospectively analyzed. Under the guidance of electronic colonoscope, 4% formaldehyde combined with 5-aminosalicylic acid (5-ASA) suppositories was topically applied. Patients were followed up for two months after treatment, and the therapeutic effectiveness was observed and analyzed. RESULTS: The rectal bleeding due to CRP was markedly reduced after topical application of 4% formaldehyde under colonoscope in all 13 patients. The bleeding stopped after one treatment session in 11 patients and after the second session in 2 patients. 5-ASA was also applied along with the use of 4% formaldehyde. The therapeutic effectiveness was satisfactory during the 1- and 2-month follow-up period. CONCLUSION: Topical application of 4% formaldehyde under the direct vision of colonoscope as a minimally invasive treatment for CRB-induced bleeding is a simple, effective, affordable, and repeatable technique without obvious complications, which deserves further exploration and promotion.

Adult sacrococcygeal teratoma: a retrospective study over eight years at a single institution.

OBJECTIVE: To determine the clinical, imaging, and histological features, and surgical resection modalities and outcomes of adult sacrococcygeal teratoma (SCT). METHODS: Adult patients with histopathologically diagnosed SCT were enrolled in our hospital between August 2010 and August 2018. Each patient's characteristics and clinical information were reviewed. RESULTS: There were 8 patients in the study (2 males, 6 females) with a median age of 34 years (range, 18-67 years). The time to clinical symptoms was 14 d to 35 years, with a median time of 4 years. Six patients presented with symptoms of sacrococcygeal pain, and four with signs of sacrococcygeal mass and ulceration in the sacrococcygeal region. Six patients were evaluated using a combination of computed tomography (CT) and magnetic resonance imaging (MRI). All patients showed a presacral tumor with heterogeneous intensity on CT images. All patients underwent surgical treatment, including 6 parasacral, 1 transabdominal, and 1 combined anterior-posterior surgery cases. Seven patients were histopathologically diagnosed with benign mature SCT, and have shown no recurrence. One patient had malignant SCT, with recurrence at 84 months after surgery. After a second surgery, the patient had no recurrence within 6 months follow-up after re-resection. CONCLUSIONS: Our retrospective study demonstrated: (1) adult SCT is difficult to diagnose because of a lack of typical clinical symptoms and signs; (2) a combination of CT and MRI examination is beneficial for preoperative diagnosis; (3) the choice of surgical approach and surgical resection modality depends on the size, location, and components of the tumor, which can be defined from preoperative CT and MRI evaluation; (4) most adult SCTs are benign; the surgical outcome for the malignant SCT patient was good after complete resection. Even for the patient with recurrent malignant SCT, the surgical outcome was good after re-resection.

Conversion chemotherapy with capecitabine and oxaliplatin for colorectal cancer with potentially resectable liver metastases: A phase II, open-label, single-arm study.

AIM: The aim of this is study is to assess the efficacy and safety of conversion capecitabine plus oxaliplatin (XELOX) in Chinese patients with potentially resectable colorectal liver metastases (CLMs). PATIENTS AND METHODS: Thirty patients (median age 57.5 years) with potentially resectable CLMs were treated with XELOX in a single-arm, open-label, nonrandomized, multicenter clinical trial. RESULTS: The objective response rate in the 30 patients was 40% (95% confidence interval: 22.7%-59.4%), and the rate of conversion to resectable CLMs was 43.3%. Patients who underwent liver resection (n = 11) had a longer median progression-free survival and overall survival than those who did not. XELOX showed an acceptable safety profile. CONCLUSION: XELOX may effectively convert potentially resectable CLM into resectable CLM, providing survival benefits with a favorable safety profile. CLINICAL TRIALS.GOV IDENTIFIER: NCT 00997685.

[Clinical study of hand-assisted laparoscopic total colectomy for colonic inertia].

OBJECTIVE: To compare the efficacy of hand-assisted laparoscopic surgery (HALS) with that of open surgery (OS) in total colectomy, and to evaluate the feasibility of hand-assisted laparoscopic total colectomy for colonic inertia. METHODS: A total of 42 patients of colonic inertia received total colectomy from January 2001 to June 2006 were randomly allocated to OS group (n = 22) and HALS group (n = 20). Data as clinical manifestation, perioperative features including operative time, intraoperative blood loss and incision length, postoperative features including first flatus-passing time, first fluid-feeding time, hospitalization time, early postoperative complications, and hospitalizing expense were recorded and compared in the two groups. Postoperative defecating frequency was followed up in both groups. RESULTS: All patients underwent total colectomy successfully and no death of operation occurred. The clinical features, operative time and blood loss were similar for the two groups. Incision length, first flatus-passing time, first fluids-feeding time, hospitalization time were better in HALS group than those in OS group. But mean hospitalizing expense in HALS group was higher than that in OS group. One case of incision infection and one intestinal obstruction occurred in OS group. No complication occurred in HALS group. Patients were followed up for 2 - 14 months, in the meantime the average defecating frequency was 3.55 +/- 1.80/d. CONCLUSIONS: HALS and open total colectomy are safe, rapid and effective surgical procedures for colonic inertia. HALS can result in a better cosmetic effect and a quicker postoperative recovery.

Cutaneous metastasis: a rare phenomenon of colorectal cancer.

Cutaneous metastases from colorectal cancer are extremely rare and generally appear several years after diagnosis or resection of the primary tumor. Although this phenomenon is uncommon, it is very important and often indicates a poor prognosis. We present a case of a 76-year-old female patient with multiple cutaneous metastatic nodules on the back, just 1 month after resection of rectal cancer. Unfortunately, the patient gave up the follow-up treatment due to her age and poor physical condition; she died 3 months later. In view of its rarity of occurrence and lack of experience in treatment, we reviewed the literature and report as follows.

Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches.

PURPOSE: To demonstrate the feasibility, safety, and technical strategies of hand-assisted laparoscopic complete mesocolic excision (HAL-CME) and to compare oncological outcomes between HAL-CME and the open approach (O-CME) for right colon cancers. METHODS: Patients who were scheduled to undergo a right hemicolectomy were divided into HAL-CME and O-CME groups. Measured outcomes included demographic variables, perioperative parameters, and follow-up data. Demographic variables included age, sex distribution, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, previous abdominal surgery, tumor localization, and potential comorbidities. Perioperative parameters included incision length, operative time, blood loss, conversion rate, postoperative pain score, postoperative first passage of flatus, duration of hospital stay, total cost, number of lymph nodes retrieved, TNM classification, and postoperative complications. Follow-up data included follow-up time, use of chemotherapy, local recurrence rate, distant metastasis rate, and short-term survival rate. RESULTS: In total, 150 patients (HAL-CME, 78; O-CME, 72) were included. The groups were similar in age, sex distribution, BMI, ASA classification, history of previous abdominal surgeries, tumor localization, and potential comorbidities. Patients in the HAL-CME group had shorter incision lengths, longer operative times, less operative blood loss, lower pain scores, earlier first passage of flatus, shorter hospital stay, higher total costs, similar numbers of lymph nodes retrieved, similar TNM classifications, and a comparable incidence of postoperative complications. The 2 groups were also similar in local recurrence rate, distant metastasis rate, and short-term survival rate. CONCLUSION: The results demonstrate that the HAL-CME procedure is a safe, valid, and feasible surgical method for right hemicolon cancers.

[Clinical application of biofragmentable anastomosis ring for intestinal anastomosis].

OBJECTIVE: To compare the efficacy of the biofragmentable anastomotic ring (BAR) with conventional hand-sutured and stapling techniques,and to evaluate the safety and applicability of the BAR in intestinal anastomosis. METHODS: The totol of 498 patients performed intestinal anastomosis from January 2000 to November 2005 were allocated to BAR group (n=186), hand-sutured group (n=177) and linear cutter group (n=135). The operative time, postoperative convalescence and corresponding complication were recorded. Postoperative anastomotic inflammation and anastomotic stenosis were observed during half or one year follow-up of 436 patients. RESULT: The operative time was (102 +/- 16) min in the BAR group, (121 +/- 15) min in the hand-sutured group, and (105 +/- 18 ) min in the linear cutter group. The difference was significant statistically (P <0.05). The operative time in BAR group and linear cutter group was shorter than hand-sutured group. One case of anastomotic leakage was noted in the BAR group, one case in the hand-sutured group, and none in the linear cutter group. They were cured by conservative methods. One case of anastomotic obstruction happened in the BAR group, one case in the hand-sutured group. Two of them were cured by conservative methods. Two cases of anastomotic obstruction happened in the hand-sutured group. However, one of them required reoperation to remove the obstruction. In the BAR, hand-sutured and the linear cutter group, the postoperative first flatus time was (67.2+/- 4.6) h, (70.2 +/- 5.8) h and (69.2 +/- 6.2)h, respectively. No significant differences were observed among three groups(P > 0.05). The rate of postoperative anastomotic inflammation was 3.0 % (5/164) in the BAR group, 47.8 % (76/159) in hand-sutured group and 7.1 % (8/113) in the linear cutter group. The difference was significant statistically (P <0.05). The rate of postoperative anastomotic inflammation in the BAR group and in the linear cutter group was less than that in hand-sutured group. CONCLUSION: BAR is one of rapid,safe and effective methods in intestinal anastomosis. It has less anastomotic inflammatory reaction than hand-sutured technique. It should be considered equal to manual and stapler methods.

Schwannoma of the colon: A case report and review of the literature.

Colonic schwannomas are rare gastrointestinal mesenchymal tumors, and only a limited number of cases has been reported. The occurrence of these tumors is less common in the large intestine than in the stomach. The present study reports a case of colonic schwannoma in a 62-year-old female patient with no specific symptoms. The patient was diagnosed with a mass in the ascending colon by colonoscopy and abdominal computed tomography scanning. A right hemicolectomy was performed. The postoperative pathological diagnosis was ascending schwannoma. This case is noteworthy as colonic schwannomas are rare and are typically treated as colon cancer. No recurrence of the lesion was observed after 24 months of follow-up.

A Modified Spontaneously Closed Defunctioning Tube Ileostomy After Anterior Resection of the Rectum for Rectal Cancer with a Low Colorectal Anastomosis.

The aim of this study is to introduce a new technique of modified spontaneously closed defunctioning tube ileostomy after anterior resection of the rectum for rectal cancer with a low colorectal anastomosis. Patients with rectal cancer who underwent anterior resection of rectum with a low colorectal anastomosis and chose a modified defunctioning tube ileostomy between March 2012 and August 2013 were retrospectively reviewed. Data on the success of the operation procedures, post-operative hospital stay, and post-operative tube ileostomy-related complications were analyzed. One hundred fifty-two patients (87 males and 65 females; 57.1 ± 17.4 years) undergoing the modified defunctioning tube ileostomy after anterior resection for rectal cancer were included. The post-operative hospital stay was 11.9 ± 3.2 days. The tube was removed on days 22.6 ± 4.1 after operation and the ileostomy wound closed spontaneously within 13.1 ± 1.9 days. Twenty-five patients felt tube-associated pain or discomfort, which was relieved after a period of adaptation and appropriate tube adjustment. Nine patients suffered from tube blockage and were treated successfully with saline irrigation. Two patients had intestinal obstruction, which was resolved with conservative treatment. Three patients developed leakage of the distal anastomosis: two were successfully treated with conservative measures and the other completely recovered after reoperation. The modified spontaneously closed defunctioning tube ileostomy appears efficacious and safe. This technique may be used to protect the distal anastomosis and simultaneously decrease the ileostomy complications, and minimize the morbidity and mortality associated with stoma takedown.

Multi-stage resection and repair for the treatment of adult giant sacrococcygeal teratoma: A case report and literature review.

Sacrococcygeal teratoma (SCT) is a sacrococcygeal neoplasm derived from more than one primitive germ layer and is only occasionally encountered in adults. The primary treatment for all primary SCTs is surgical excision. The present study reports the case of a giant SCT in a middle-aged female with a history lasting >3 decades. Multi-staged surgical treatment was performed, including ileostomy plus tumor excision, four debridement plus flap repair procedures, and closure of the ileostomy. Follow-up showed improved quality of life without evidence of local recurrence after resection. The study also presents a brief overview of the relevant literature. To the best of our knowledge, this is the first report of multi-staged surgical treatment for giant SCT in an adult patient.

Malone Antegrade Continence Enema in Patients with Perineal Colostomy After Rectal Resection.

The objective of this study was to evaluate the value of antegrade continence enema (Malone operation) in abdominoperineal resection (Miles' operation). Between January 2008 and May 2009, five cancer patients (two men and three women) underwent abdominoperineal resection and digestive reconstruction by perineal colostomy and Malone antegrade continence enema in our institution. Their functional results and quality of life were recorded. None of the patients died, but two had wound infections and one experienced urinary retention. Patients performed antegrade enema every 24 h with 2,000 mL of normal saline by themselves. The duration of the enema lasted for an average of approximately 35 min, and fecal contamination was not detected at 24 h. Patient satisfaction was determined to be 88 %. Malone antegrade continence enema associated with abdominoperineal resection and perineal colostomy provided acceptable continence. It preserved the body image of the patients and resulted in a satisfactory quality of life. It is a potential alternative for patients who are not willing to have a permanent colostomy.

[Minilaparotomy approach for curative resection of colorectal cancer].

OBJECTIVE: To evaluate the feasibility and safety of a minilaparotomy approach for curative resection of colorectal cancer in comparison with the conventional laparotomy. METHODS: Seventy-eight patients underwent radical resection for rectal cancer with minilaparotomy during April 2001 to December 2002. The minilaparotomy involved complete resection and a skin incision 2 cm above the link line of left anterior superior iliac spine to pubic symphysis and was about 7-10 cm in length. Another 86 patients who served as control group underwent a similar resection with a conventional laparotomy during the same period. RESULT: The minilaparotomy approach was successful in all 78 patients. The general status of patients, operative types and histopathological features of tumor were similar in the two groups (P>0.05). Operative blood loss in control group was greater (P<0.001), whereas incision length in minilaparotomy group was significantly shorter than that in conventional laparotomy (9.38 cm compared with 17.32 cm). The operative time, analgesia requirement, first passing flatus,first oral fluids and postoperative hospital stay were significantly shorter in the minilaparotomy group (P<0. 001). In an average 25.4-month follow-up, there were no tumor recurrences in the minilaparotomy group. CONCLUSION: A minilaparotomy approach for curative resection of rectal cancer may be an ideal alternative approach to conventional laparotomy.

[The prognosis of the total proctocolectomy and ileal-pouch anal anastomosis].

OBJECTIVE: To evaluate the prognosis of the total proctocolectomy and ileal-pouch anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). METHODS: Sixty-one patients with ulcer colitis or familial adenomatous polyposis were performed total proctocolectomy and ileal pouches-anal anastomosis during 1985 to 2002. There are S type pouch 25 cases, S-J type pouch 13 cases, J type pouch 17 cases and W type pouch 6 cases. The complication and function after the IPAA were also discussed. RESULTS: No patient died after operation. The total morbidity is 16% (10/61), the morbidity of group UC (6/25) is higher than FAP's (4/34). The W type pouch's morbidity is higher than other three types', the operation with stapled technique is associated with fewer complication than hand-sewn IPAA (2/20 vs 8/41), however, there is also no significant difference between them. The number of stools per 24 hours is 4.2, the percent of the normal continence of daytime and nighttime is 84% (43/51) and 75% (38/51) respectively. There's only about 6% (3/51) patient with fecal incontinence. The most patients are satisfied with IPAA. CONCLUSION: The proctocolectomy ileal pouch-anal anastomosis for FAP and UC has few complication with accepted frequency and preserve a good anal function, it is an ideal alternative approach.

Enterostomy can decrease the mortality of patients with Fournier gangrene.

AIM: To determine the significance of enterostomy in the emergency management of Fournier gangrene. METHODS: The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed. RESULTS: The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P < 0.05) and average length of hospital stay (14.3 ± 7.8 d vs 20.1 ± 8.9 d, P < 0.05) were shorter in the enterostomy group. The case fatality rate was lower in the enterostomy group than that in the control group (3.6% vs 21.7%, P < 0.05). CONCLUSION: Enterostomy can decrease the case fatality rate of patients with Fournier gangrene.