THE MANAGEMENT OF INFECTIOUS AND NONINFECTIOUS ANORECTAL COMPLICATIONS IN PATIENTS WITH LEUKEMIA

BACKGROUND: Infectious and noninfectious anorectal complications may o ccur in patients undergoing therapy for leukemia. Controversy surround s the treatment of this problem in immunocompromised patients. STUDY D ESIGN: A retrospective review of the medical records of 83 patients wi th acute or chronic leukemia in whom anorectal disease was performed t o determine the initial signs and symptoms, treatment, and outcomes. R ESULTS: During a 12-year period, 92 patients with anorectal complicati ons were treated. This series included 25 patients with perirectal abs cesses, 22 patients with anal fissures, 18 patients with symptomatic e xternal hemorrhoids, 12 patients with perianal ulcerations, 12 patient s with symptomatic internal hemorrhoids, and three patients with fistu las in ano. Overall, 79 (86 percent) of the 92 anorectal complications resolved in 68 of the 83 patients. Increasing periods of neutropenia did not adversely affect the resolution of anorectal disease. Thirteen patients (16 percent) required surgical intervention, most commonly s econdary to a perirectal abscess. Incision and drainage was necessary in ten (40 percent) of 25 patients with perirectal abscess, which incl uded five patients with fluctuation and five patients in whom infectio n failed to respond to medical therapy. CONCLUSIONS: Noninfectious ano rectal complications in patients with leukemia respond to nonoperative intervention and rarely progress to a life-threatening infection. Non operative intervention in the form of systemic antibiotics and sitz ba ths is successful in the treatment of infectious anorectal complicatio ns. Incision and drainage should be performed when fluctuation is pres ent and in patients whose complications fail to respond to medical the rapy.