Perianal infections in acute leukemia. Second place winner: Conrad Jobst Award

Perianal infections in patients with acute leukemia and granulocytopenia are potentially lethal conditions. To evaluate the management of perianal infections in patients with granulocytopenia and acute leukemia, all such patients treated at Emory University Hospital between January 1, 1980, and December 31, 1985, were reviewed. Twenty patients were found to have severe granulocytopenia (fewer than 500 polymorphonuclear leukocytes/mm3) and perianal infection, representing 5.7 per cent of all hematology service admissions during that period. Eleven patients were managed conservatively with broad-spectrum antibiotics and supportive measures, and nine patients underwent operative drainage of the perianal infection in addition to conservative measures. The two groups were similar in respect to age, associated conditions, length of hospitalization, and degree of perianal infection, with the exception that operatively drained patients were more likely to have positive blood cultures (7/9 operatively drained; 4/11 conservatively managed). Mortality was higher in the operatively drained group (44.4% vs 9% in the conservatively managed), and three patients had progression of the local infection after drainage, two of whom required a diverting colostomy. The overall mortality attributed to perianal disease in these severely granulocytopenic patients was 25 per cent. From this review, operative drainage of perianal infection does not appear to increase survival or decrease morbidity in patients with severe granulocytopenia.