Management of acute colorectal diseases in febrile neutropenic patients

Abstract

Patients with hematologic malignancies are susceptible to serious complications due to immunosuppression. Neutropenic-related infection is one of the major causes of morbidity and mortality in this group of diseases. Febrile neutropenia is a common complication of the hematologic neoplasm itself or chemotherapy, and has worse prognosis if prolonged (lasting more than 7 days) or severe (neutrophil count below 500 cells per μL). Among the usual sites of infection, we highlight the neutropenic enterocolitis and perianal infection as gastrointestinal complications of greater interest to the colorectal surgeon. Although most cases respond to conservative treatment, a portion of patients will need surgery for complete recovery.

Anorectal Complications During Neutropenic Period in Patients With Hematologic Diseases

“…Manifestations of perianal infections may differ from those with a competent immune system 3 and are often accompanied by severe pain, swelling, constipation, and may cause systemic infection. 6 However, the clinical presentation of an anorectal infection is often masked by the absence of inflammatory cells so recognition of the signs and symptoms can be difficult in neutropenic patients.…”

“… 7 Perianal infections are a life-threatening complication including Fournier’s gangrene that requires rapid diagnosis and intervention as recurrence and mortality rates may be expressive. 3 , 8 In a series of 92 patients with acute or chronic leukemia, most common manifestations were a perirectal abscess (27%) followed by anal fissures (23%), external hemorrhoids (19%) and perianal ulcerations (13%). 3 Another retrospective study found a perianal infection prevalence of 6.7% and recurrence was diagnosed in 31% of the cases.…”

“… 3 , 8 In a series of 92 patients with acute or chronic leukemia, most common manifestations were a perirectal abscess (27%) followed by anal fissures (23%), external hemorrhoids (19%) and perianal ulcerations (13%). 3 Another retrospective study found a perianal infection prevalence of 6.7% and recurrence was diagnosed in 31% of the cases. 3 Grewal et al 4 reported that 5.8% patients hospitalized with leukemia had the concomitant symptomatic anorectal disease.…”

“…Febrile neutropenia is an important cause of mortality occurring commonly after myelosuppressive treatment in cancer patients. 1 , 2 Neutropenic patients are susceptible to any anorectal complications, 3 and symptomatic anorectal pathology afflicts 2–32% of oncology patients. 4 Perianal infections (represented by an abscess or infected fistula) are the most feared complication, considering the lack of natural defense against infectious microorganisms.…”

“… 4 Perianal infections (represented by an abscess or infected fistula) are the most feared complication, considering the lack of natural defense against infectious microorganisms. 3 The incidence of perianal infection is approximately 8–9% of patients with acute leukemia. 5 When septic complications develop, the anorectal disease is potentially fatal, especially in neutropenic patients, in whom mortality rates range from 11–57%.…”