Severe Anal and Abdominal Pain Due to Typhlitis in a Leukemic Patient

Nada, Eman; Alshoaiby, Ali N.; Alaskar, Ahmad; Khan, Ali

doi:10.1016/j.jpainsymman.2007.07.003

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…Perianal infection is not uncommon in patients with hematological malignancy [8]–[14]. Leukemic patients receiving chemotherapy and radiotherapy with resultant anal mucosa damage can provide an essential port of entry for pathogens during nadir stage [8]–[14]. The Disease spectrum of perianal infection might range from mild local cellulitis to life-threatening sepsis in patients with chemotherapy related neutropenia.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, neutropenic patients are unable to mount an adequate inflammatory response and are susceptible to infection by less virulent micro-organisms, consequently they may have unusual presentations of infection [15]. Not only can perianal infection cause mortality, but anal pain and discomfort also significantly impact the quality of life in patients with acute leukemia [14].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Microbiological Characteristics of Perianal Infections in Adult Patients with Acute Leukemia

et al. 2013

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BackgroundPerianal infection is a common problem for patients with acute leukemia. However, neutropenia and bleeding tendency are relatively contraindicated to surgical intervention. The epidemiology, microbiology, clinical manifestations and outcomes of perianal infection in leukemic patients are also rarely discussed.MethodThe medical records of 1102 adult patients with acute leukemia at a tertiary medical center in Taiwan between 2001 and 2010 were retrospectively reviewed and analyzed.ResultThe prevalence of perianal infection was 6.7% (74 of 1102) in adult patients with acute leukemia. Twenty-three (31%) of the 74 patients had recurrent episodes of perianal infections. Patients with acute myeloid leukemia had higher recurrent rates than acute lymphoblastic leukemia patients (p = 0.028). More than half (n = 61, 53%) of the perianal infections were caused by gram-negative bacilli, followed by gram-positive cocci (n = 36, 31%), anaerobes (n = 18, 15%) and Candida (n = 1, 1%) from pus culture. Eighteen patients experienced bacteremia (n = 24) or candidemia (n = 1). Overall 41 (68%) of 60 patients had polymicrobial infection. Escherichia coli (25%) was the most common micro-organism isolated, followed by Enterococcus species (22%), Klebsiella pneumoniae (13%), and Bacteroides species (11%). Twenty-five (34%) of 74 patients received surgical intervention. Acute leukemia patients with surgically managed anal fistulas tended to have fewer recurrences (p = 0.067). Four (5%) patients died within 30 days after diagnosis of perianal infection. Univariate analysis of 30-day survival revealed the elderly (≧ 65 years) (p = 0.015) and patients with shock (p<0.001) had worse outcome. Multivariate analysis showed septic shock to be the independent predictive factor of 30-day crude mortality of perianal infections (p = 0.016).ConclusionPerianal infections were common and had high recurrence rate in adult patients with acute leukemia. Empirical broad-spectrum antibiotics with anaerobic coverage should be considered. Shock independently predicted 30-day crude mortality. Surgical intervention for perianal infection remains challenging in patients with acute leukemia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and Microbiological Characteristics of Perianal Infections in Adult Patients with Acute Leukemia

et al. 2013

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“…Anal mucosal damage and related lesions may develop in leukemic patients who develop neutropenia as a result of chemotherapy and radiotherapy. These neutropenic patients cannot show an adequate inflammatory response, and therefore even weaker virulent microorganisms can cause life-threatening perianal infections (2).…”

Section: Introductionmentioning

confidence: 99%

The role of surgery in perianal disease developing in hematology malignancy patients

ERKAN

Gündoğdu²,

Kus³

et al. 2023

Interdisciplinary Medical Journal

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Objective: Perianal diseases may impair the comfort of life in immunosuppressive patients as well as cause life-threatening complications. In this study, we aimed to analyze the surgical management and results of perianal region diseases in hematological patients who were consulted by the hematology clinic and to present non-surgical treatment options in these patients. Method: The files of the patients who were consulted by the Hematology Clinic of our hospital between January 2011 and January 2021 due to perianal disease were retrospectively reviewed. Patients with multiple data deficiencies were excluded from the study. Gender, age, hematological diagnosis, neutropenic status, number of consultations, surgical diagnosis, radiological imaging methods, treatment modalities and survival data of the patients were recorded. Results: A total of 911 consultations were requested from 627 patients. The number of patients consulted with the diagnosis of perianal disease was 147. Ninety (61.2%) of the patients were male and 57 (38.7%) were female. Of the patients, 74 (50.3%) had acute myeloid leukemia, 29 (19.7%) lymphoma, 15 (10.2%) acute lymphoblastic leukemia, 12 (8.1%) myelodysplastic syndrome, 10 (6.8%) multiple myeloma, 7 (4.7%) of them were followed up with the diagnosis of chronic lymphocytic leukemia, 53 (36%) patients had additional systemic disease besides hematological disease. All patients were examined and prediagnosed. Magnetic resonance imaging was performed in 72 patients with suspected abscess and fistula. Surgical treatment methods were applied to 30 (20.4%) of the patients. Conclusion: Perianal diseases frequently accompany hematological diseases, especially in neutropenic periods. With early examination, close follow-up and appropriate treatment, surgical necessity and the number of relapsed diseases can be minimized.

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“…Perianal enfeksiyonlara sıklıkla şiddetli ağrı, şişkinlik, kabızlık eşlik eder ve sistemik enfeksiyon ve hayatı tehdit eden sepsise neden olabilir [5,6]. Perianal enfeksiyon mortaliteye neden olabilirken, anal ağrı ve rahatsızlık hissi de akut lösemi hastalarında yaşam kalitesini önemli ölçüde etkiler [7]. Nötropeni, perianal sepsis için en önemli risk faktörlerinden biridir.…”

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“…Kemoterapi ve radyoterapi sonucu nötropeni gelişen lösemik hastalarda anal mukozal hasar ve buna bağlı lezyonlar gelişebilir. Bu nötropenik hastalar yeterli bir iltihap tepkisi gösterememekte ve bundan dolayı daha az virülan mikroorganizmalar hayatı tehdit eden perianal enfeksiyonlar oluşturabilmektedir [7]. Perianal enfeksiyonların hafif lokal bir selülitten hayatı tehdit eden sepsise kadar değişkenlik gösteren klinik durumundan dolayı nötropenik hastalarda enfeksiyonu tanımak zor olabilir.…”

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Prevalence and current management of perianal diseases in patients with acute leukemia

et al. 2018

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Severe Anal and Abdominal Pain Due to Typhlitis in a Leukemic Patient

Cited by 4 publications

References 14 publications

Clinical and Microbiological Characteristics of Perianal Infections in Adult Patients with Acute Leukemia

Clinical and Microbiological Characteristics of Perianal Infections in Adult Patients with Acute Leukemia

The role of surgery in perianal disease developing in hematology malignancy patients

Prevalence and current management of perianal diseases in patients with acute leukemia

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