Perirectal infections in acute leukemia. Improved survival after incision and debridement

Area of Science:

• Oncology
• Infectious Diseases
• Surgical Oncology

Background:

• Perirectal infections are a serious complication in patients with acute leukemia.
• Severe neutropenia, often below 100 cells/mm³, is a common characteristic in these patients.
• These infections present as painful, indurated lesions, frequently accompanied by systemic symptoms.

Purpose of the Study:

• To investigate the incidence and characteristics of perirectal infections in acute leukemia patients.
• To evaluate the efficacy of early surgical intervention, specifically incision and debridement, in managing these infections.
• To determine the impact of treatment strategies on patient outcomes, including pain, fever, bacteremia, and survival.

Main Methods:

• A retrospective review of 202 acute leukemia patients over a 6-year period.
• Identification of patients who developed perirectal infections.
• Analysis of clinical presentation, laboratory findings (including neutrophil counts and bacteremia), and treatment modalities (surgical vs. non-surgical management).

Main Results:

• 16 (7.9%) of 202 patients developed perirectal infections, all with severe neutropenia.
• Common complications included urinary retention, peritoneal signs, and genital extension.
• Eleven patients had bacteremia with enteric bacteria; 10 underwent incision and debridement, experiencing rapid symptom resolution and healing. The patient not treated with incision died.
• Fifteen patients with drained lesions recovered, with 13 surviving hospitalization.

Conclusions:

• Perirectal infections are a significant concern in acute leukemia patients with severe neutropenia.
• Prompt surgical incision and debridement of perirectal abscesses are crucial for managing these infections.
• Early surgical intervention is associated with improved patient outcomes and survival in this vulnerable population.