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

During a 6-year period, 16 (7.9%) of 202 patients with acute leukemia of both the lymphocytic and nonlymphocytic types developed perirectal infections. All patients were febrile and severely neutropenic (14 patients had absolute neutrophil counts of less than 100/mm3). Lesions were painful and indurated but lacked fluctuance. Urinary retention, peritoneal signs, and extension of the infection to the genitalia were common. Eleven patients had bacteremia, and an average of 2.1 enteric bacteria were recovered from samples of abscess fluid or blood. Perirectal lesions were operatively incised and debrided (10 patients), unless spontaneous drainage occurred (5 patients). These 15 patients became pain-free in less than 48 hours and afebrile in 2 to 8 days. Drained lesions healed in all. Thirteen of fifteen patients left the hospital, whereas 2 died in the hospital of unrelated causes. The only patient whose lesion was not drained died of continuous bacteremia. Early incision and debridement contributed to our patients' improved survival.