Management of acute rectal problems in leukemic patients.

In the interval 1944-1983, 54 patients with leukemia and acute rectal pathology were seen at our institution, including: 25 patients with perirectal abscesses and/or fistulas (PF/F), 16 patients with acutely prolapsed or thrombosed hemorrhoids, 11 patients with anal fissures with or without hemorrhoids, and 2 patients with perianal excoriations. In the past, concerns have been raised about development of septicemia secondary to diagnostic or therapeutic instrumentation. In only 4 of 54 cases did the clinical course clearly suggest digital examination or instrumentation of the rectum may have caused bacteremia though 13 of 54 patients had positive blood cultures for gram negative organisms at some time during their course of which 7 were clearly coliform. Most (42/54) patients were treated initially by sitz baths, suppositories, and stool softeners and/or antibiotics. We observed five patients only and treated two by radiotherapy. Eleven patients required surgical intervention for thrombosed hemorrhoids and perirectal abscess and/or fistulas. Eight other patients with PA/F drained spontaneously. Poor healing after surgical or spontaneous drainage was documented in only one case. This study suggests that sitz baths, suppositories, antibiotics, and judicious surgical drainage (where needed) form the core of therapy for these patients.