PURPOSE: This study was designed to evaluate the spectrum, clinical presentation, management, and outcome of anorectal disease in neutropenic leukemic patients and to compare operative and nonoperative management in neutropenic leukemic patients. METHODS: A retrospective review of hospital records was performed. RESULTS: One hundred fifty-one of 2,618 (5.8 percent) patients hospitalized with leukemia had concomitant symptomatic anorectal disease. Data from 81 patients were available for analysis. Fifty-two (64 percent) were treated nonoperatively and 29 (36 percent) underwent operative treatment. Fifty-seven (70.4 percent) had absolute neutrophil counts < 1,000/mm3, and 54 (66.7 percent) were severely neutropenic (absolute neutrophil count < 500/mm3). Management and outcomes of 54 severely neutropenic patients were analyzed. In 20 patients who underwent surgery there were 4 deaths (20 percent) and 4 recurrences (20 percent), whereas in 34 patients managed nonoperatively there were 6 deaths (18 percent) and 4 recurrences (12 percent) (P > 0.05). CONCLUSIONS: Symptomatic anorectal disease afflicted 5.8 percent of hospitalized leukemic patients. In these patients, anorectal sepsis was a major source of mortality. Our data suggest that anorectal abscesses in neutropenic leukemic patients may be safely drained. Because we did not observe excessive morbidity or mortality (20 percent vs. 18 percent) in the operated neutropenic leukemics as compared with the nonoperated patients, selected neutropenic leukemic patients should not be denied anorectal surgery when otherwise indicated.
PURPOSE: This study was designed to evaluate the spectrum, clinical presentation, management, and outcome of anorectal disease in neutropenic leukemicpatients and to compare operative and nonoperative management in neutropenic leukemicpatients. METHODS: A retrospective review of hospital records was performed. RESULTS: One hundred fifty-one of 2,618 (5.8 percent) patients hospitalized with leukemia had concomitant symptomatic anorectal disease. Data from 81 patients were available for analysis. Fifty-two (64 percent) were treated nonoperatively and 29 (36 percent) underwent operative treatment. Fifty-seven (70.4 percent) had absolute neutrophil counts < 1,000/mm3, and 54 (66.7 percent) were severely neutropenic (absolute neutrophil count < 500/mm3). Management and outcomes of 54 severely neutropenicpatients were analyzed. In 20 patients who underwent surgery there were 4 deaths (20 percent) and 4 recurrences (20 percent), whereas in 34 patients managed nonoperatively there were 6 deaths (18 percent) and 4 recurrences (12 percent) (P > 0.05). CONCLUSIONS: Symptomatic anorectal disease afflicted 5.8 percent of hospitalized leukemicpatients. In these patients, anorectal sepsis was a major source of mortality. Our data suggest that anorectal abscesses in neutropenic leukemicpatients may be safely drained. Because we did not observe excessive morbidity or mortality (20 percent vs. 18 percent) in the operated neutropenic leukemics as compared with the nonoperated patients, selected neutropenic leukemicpatients should not be denied anorectal surgery when otherwise indicated.
Authors: Antonio Tarasconi; Gennaro Perrone; Justin Davies; Raul Coimbra; Ernest Moore; Francesco Azzaroli; Hariscine Abongwa; Belinda De Simone; Gaetano Gallo; Giorgio Rossi; Fikri Abu-Zidan; Vanni Agnoletti; Gianluigi de'Angelis; Nicola de'Angelis; Luca Ansaloni; Gian Luca Baiocchi; Paolo Carcoforo; Marco Ceresoli; Alain Chichom-Mefire; Salomone Di Saverio; Federica Gaiani; Mario Giuffrida; Andreas Hecker; Kenji Inaba; Michael Kelly; Andrew Kirkpatrick; Yoram Kluger; Ari Leppäniemi; Andrey Litvin; Carlos Ordoñez; Vittoria Pattonieri; Andrew Peitzman; Manos Pikoulis; Boris Sakakushev; Massimo Sartelli; Vishal Shelat; Edward Tan; Mario Testini; George Velmahos; Imtiaz Wani; Dieter Weber; Walter Biffl; Federico Coccolini; Fausto Catena Journal: World J Emerg Surg Date: 2021-09-16 Impact factor: 5.469