Perianal sepsis in neutropaenic patients with haematological malignancies: the role of magnetic resonance imaging and surgery

Ashkar, Claudia; Britto, Maneka; Carne, Peter; Cheung, Wa; Mirbagheri, Naseem

doi:10.1111/ans.15744

Cited by 4 publications

(6 citation statements)

References 15 publications

(40 reference statements)

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“…Anorectal infections in neutropenic leukemia patients are not uncommon and represent a potentially fatal complication [13][14][15]. The pathogenesis of anorectal infections in neutropenic leukemia patients is incompletely understood and probably multifactorial due to the combination of mucosal injury from cytotoxic chemotherapy or constipation-induced trauma, the presence of neutropenia and an impaired local (mucosal) and systemic host defense [3,11,16].…”

Section: Background and Pathogenesismentioning

confidence: 99%

“…The exact route of entry of pathogens into the perianal region in neutropenic patients remains unclear, but it is believed that while the presence of mucosal injury provides the port of entry of pathogens, neutropenia and the presence of opportunistic infections facilitate the development of anorectal infections [13,15,17]. Further risk factors include the presence of comorbidities, such as diabetes mellitus or preexisting anorectal conditions, like hemorrhoids or fissures [16,[22][23][24].…”

Section: Background and Pathogenesismentioning

confidence: 99%

“…Since certain types of abscesses, such as an intersphincteric abscess, may not be visible on inspection, digital rectal examination (DRE) can be helpful in establishing the diagnosis in the immunocompetent patients [12]. However, undertaking DRE in the immunosuppressed patients is currently highly discouraged due to concerns of breaching mucosal barriers and worsening septicemia, despite controversial opinions [15,16,28]. Physical examination may also reveal enlarged inguinal lymph nodes.…”

Section: Diagnosismentioning

confidence: 99%

“…Radiographic imaging modalities are reliable diagnostic tools for the assessment of anorectal infections and include ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) [15].…”

Section: Diagnosismentioning

confidence: 99%

“…Therefore, MRI scans are the preferred option for the evaluation of anorectal infections in this patient population, as they can establish the pathological anatomy in nearly all forms of anorectal infections with an accuracy of 90%. Moreover, MRI is more accurate for the illustration of soft tissue changes, edema formation, fluid collection and demonstration of complex fistula tracts, although these are less common in patients with hematological malignancies [13,15,32,33]. In T2-weighted sequences, tissue inflammation and abscesses are hyperintense with peripheral enhancement and central diffusion restriction [34].…”

Section: Diagnosismentioning

confidence: 99%

See 4 more Smart Citations

Anorectal Infections in Neutropenic Leukemia Patients: A Common Clinical Challenge

Babakhanlou,

Ravandi-Kashani,

Hita

et al. 2024

J Hematol

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Anorectal infections in neutropenic leukemia patients are a significant and potentially life-threatening complication. The pathogenesis of this condition is not entirely understood and believed to be multifactorial, including mucosal injury as a result of cytotoxic drugs, profound neutropenia and impaired host defense. Establishing an early diagnosis is key and often made clinically on the basis of signs and symptoms, but also from imaging studies demonstrating perianal inflammation or fluid collection. The management of anorectal infections in neutropenic leukemia patients is not straightforward, as there are no well-conducted studies on this entity. This review seeks to provide a framework into the pathophysiology and clinical presentation of anorectal infections in neutropenic leukemia patients, propose a diagnostic approach and to discuss controversies in the management of this condition.

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Section: Background and Pathogenesismentioning

confidence: 99%

Section: Background and Pathogenesismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

See 3 more Smart Citations

Anorectal Infections in Neutropenic Leukemia Patients: A Common Clinical Challenge

Babakhanlou,

Ravandi-Kashani,

Hita

et al. 2024

J Hematol

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ACR Appropriateness Criteria® Sepsis

Brixey,

Fung,

De Leon

et al. 2024

Journal of the American College of Radiology

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Efficacy of surgical treatment of perianal infection in patients with hematological malignancy

He,

Ni,

2024

Medicine

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The efficacy of surgical intervention for perianal infection in patients with hematologic malignancies is not well established. Therefore, our study aimed to investigate the clinical efficacy and complications of surgical treatment of perianal infection in patients with hematologic malignancies. This retrospective study included patients with hematological malignancies who were diagnosed with perianal infections and treated at the China Aerospace Science & Industry Corporation 731 Hospital between 2018 and 2022. Patient characteristics, hematological data, surgical intervention, and complications, including recurrence and mortality, were analyzed. This study included 156 patients with leukemia aged 2 months to 71 years who were treated surgically for perianal infection, comprising 94 males and 62 females. Perianal infection included 36 cases of abscesses, 91 anal fistulas, and 29 anal fissures accompanied by infection. A total of 36 patients developed severe complications postoperatively, including 4 patients who died, 6 patients with severe incision bleeding, 18 patients with severe pain, 6 patients with sepsis, 12 patients who needed reoperation, 15 patients with hospitalization for more than 2 weeks, and 3 patients with anal stenosis; none of the patients developed anal incontinence. Additionally, risk factors for postoperative complications of perianal infection in patients with hematologic malignancies include leukopenia, agranulocytosis, thrombocytopenia, depth of abscess and not undergone an MRI. Surgical intervention may improve the prognosis of patients with perianal abscess formation, particularly in patients who show no improvement with medical therapy and those who develop perianal sepsis. Granulocytopenia and thrombocytopenia should be improved before surgery, which can significantly reduce postoperative complications. Although these findings are from a case series without a comparator, they may be of value to physicians because to the best of our knowledge, no randomized or prospective studies have been conducted on the management of perianal infections in patients with hematological malignancies.

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Perianal sepsis in neutropaenic patients with haematological malignancies: the role of magnetic resonance imaging and surgery

Cited by 4 publications

References 15 publications

Anorectal Infections in Neutropenic Leukemia Patients: A Common Clinical Challenge

Anorectal Infections in Neutropenic Leukemia Patients: A Common Clinical Challenge

ACR Appropriateness Criteria® Sepsis

Efficacy of surgical treatment of perianal infection in patients with hematological malignancy

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