Management of Perianal Sepsis in Neutropenic Patients With Haematological Malignancies-A Systematic Review

Despite neutropenia being considered a significant risk factor for acute perianal sepsis, there is a lack of consensus on treatment guidelines for perianal abscess in the immunocompromised patient, specifically in patients with neutropenia secondary to a haematological malignancy. The aim of the article is to review the available literature on. Whether surgical intervention produces better outcomes than a non-surgical approach for perianal sepsis in the immunocompromised patient with a haematological malignancy.

Relevant papers were identified through electronic databases including PubMed, Medline and Scopus. Data were extracted independently by two authors on a Microsoft Excel spreadsheet up to July 2024.

A total of eight studies were included in the final analysis (124 cases). Perianal or rectal pain (n = 81, 65.3%) was the most reported complaint, followed by fever (n = 72, 58.1%), swelling and induration (n = 54, 43.5%) and erythema was reported in 26 (21.0%) cases. The most common organisms cultured from blood and anorectum were Escherichia coli and Pseudomonas aeruginosa. A total of 12 deaths (18.8%) were reported out of the 64 patients who underwent conservative management, while 10 (16.7%) deaths were reported out of 60 patients who underwent surgical management. Complete wound healing or good wound granulation was achieved for 35 (54.7%) patients in the conservative group and 35 (58.3%) patients in the surgical group.

Our review suggests that conservative management is an acceptable treatment in carefully selected patients without an obvious perianal abscess on cross-sectional radiological imaging.