Surgical management of anorectal infection in the leukemic patient

Anorectal infections are a common complication in immunocompromised patients. Such infections are multifactorial in etiology, often promoted by breaks in the anorectal mucosa and depressed leukocyte counts, both secondary to chemotherapy. Because of altered immune response to infection, diagnosis of anorectal infections in leukemic patients is often delayed, with a resultant mortality of up to 78%. Management is typically supportive for fears of extension of infection or non-healing of wounds with surgical intervention. We recently encountered a 17-year-old woman who presented with an anorectal infection heralding the onset of acute nonlymphocytic leukemia. Because of her unusual presentation, chemotherapeutic induction occurred subsequent to surgical drainage of an anorectal abscess. She demonstrated adequate healing of her wounds in the early post-operative, post-induction period. Her case and a review of the current management of anorectal infections in patients with leukemia are presented.