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Khan MTA, Patnaik R, Huang JY, Campi HD, Montorfano L, De Stefano F, Rosenthal RJ, Wexner SD. Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess. Colorectal Dis 2022; 25:717-727. [PMID: 36550093 DOI: 10.1111/codi.16447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
AIM Few data are available regarding the management of anorectal abscess in patients with leukopenia. The aim of this study was to investigate the impact of leukopenia among patients undergoing incision and drainage for anorectal abscess. METHOD A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. Perianal fistulas and supralevator abscesses were excluded. Patients were grouped based on white blood cell (WBC) count: WBC < 4.5 cells/μl, WBC = 4.5-11.0 cells/μl and WBC > 11.0 cells/μl. The 30-day overall complications and outcomes were compared using regression models, accounting for demographics and comorbidities. RESULTS Ten thousand two hundred and forty (70.3% male) patients were identified. Univariate analysis showed that, compared with patients with leukocytosis (WBC > 11.0 cells/μl) and normal WBC count (WBC = 4.5-11.0 cells/μl), patients with leukopenia (WBC <4.5 cells/μl) had higher rates of overall (p < 0.001), pulmonary (p < 0.001) and haematological complications (p < 0.001). They also had higher rates of readmission (p < 0.001), reoperation (p = 0.005), discharge to a care facility (p = 0.003), increased length of hospital stay (p = 0.004) and death (p < 0.001). Multivariable analysis identified leukopenia as an independent risk factor for overall complications [odds ratio (OR) 2.31, 95% CI 1.65-3.24; p < 0.001], pulmonary complications (OR 5.65, 95% CI 1.88-16.97; p = 0.002), haematological complications (OR 4.30, 95% CI 2.94-6.28; p < 0.001), unplanned readmission (OR 2.20, 95% CI 1.43-3.40; p < 0.001), reoperation (OR 1.80, 95% CI 1.10-2.93; p = 0.019) and death (OR 2.77, 95% CI 1.02-7.52; p = 0.046). Discharge to a care facility and length of stay were not significant on multivariable analysis. CONCLUSION Leukopenia is associated with increased risk for pulmonary and haematological complications, readmissions, reoperations, discharge to a care facility and death after incision and drainage for anorectal abscess.
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Affiliation(s)
| | - Ronit Patnaik
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jian Yu Huang
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Haisar Dao Campi
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Lisandro Montorfano
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Felice De Stefano
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Raul J Rosenthal
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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Siebert M, Lucas N, Gelli M, Sourrouille I, Benhaïm L, Faron M, Micol JB, Ducreux M, Stoclin A, Honoré C. Acute Abdominal Complications in Deeply Neutropenic Onco-Hematology Patients: A Retrospective Series of 105 Cases. World J Surg 2022; 46:2389-2398. [PMID: 35816234 DOI: 10.1007/s00268-022-06653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Acute abdominal complications (AAC) in patients with deep neutropenia (DN) is challenging to manage because of the expected influence of AAC on oncological prognosis and higher surgical complication rate in a period of DN. In practice, these parameters are difficult to appreciate. This study reported our experience in managing these patients. METHODS All consecutive patients treated in our tertiary care cancer center between 2010 and 2020 who developed AAC in the context of a DN were retrospectively analyzed. AAC was defined as an infection (intra-abdominal, perineal, or cutaneous), bowel obstruction, or intra-abdominal hemorrhage. FINDINGS Among 105 patients, 18 (17%) required emergent surgery (group 1), 34 patients had a complication requiring surgical oversight (group 2), and 53 patients had a non-surgical etiology (group 3). Fifteen patients underwent surgery in the group 1, three in group 2, and one in group 3. Overall, 28 patients died during hospitalization. Mortality was statistically different between the groups (p = 0·01), with a higher rate in group 1 (n = 9/18, 50%) than in group 2 (n = 11/34, 32%) and group 3 (n = 8/53, 15%). All groups together had a median overall survival (OS) of 14 months and disease-free survival (DFS) of 10 months. OS was not comparable between the groups, and the median length of survival in group 1 was 6 months versus 8 months in group 2 and 23 months in group 3. In group 1, five patients (5/18, 28%) did not relapse at the end of the follow-up compared to 13 in group 2 (13/34, 38%) and 25 in group 3 (25/53, 47%). After discharge, OS and DFS were similar between the groups. INTERPRETATION The advent of an AAC necessitating surgery in the context of DN is a deadly event associated with a 50% mortality; nonetheless, in case of unpostponable emergencies, surgery can provide long-term survival in selected patients.
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Affiliation(s)
- Matthieu Siebert
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Nolwenn Lucas
- Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | - Isabelle Sourrouille
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | - Léonor Benhaïm
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | - Matthieu Faron
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | | | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Annabelle Stoclin
- Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
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Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, Abongwa H, De Simone B, Gallo G, Rossi G, Abu-Zidan F, Agnoletti V, de'Angelis G, de'Angelis N, Ansaloni L, Baiocchi GL, Carcoforo P, Ceresoli M, Chichom-Mefire A, Di Saverio S, Gaiani F, Giuffrida M, Hecker A, Inaba K, Kelly M, Kirkpatrick A, Kluger Y, Leppäniemi A, Litvin A, Ordoñez C, Pattonieri V, Peitzman A, Pikoulis M, Sakakushev B, Sartelli M, Shelat V, Tan E, Testini M, Velmahos G, Wani I, Weber D, Biffl W, Coccolini F, Catena F. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16:48. [PMID: 34530908 PMCID: PMC8447593 DOI: 10.1186/s13017-021-00384-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Hariscine Abongwa
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Belinda De Simone
- Department of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, Poissy, France
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Rossi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- Department of Emergency and general Surgery, Pavia University Hospital, Pavia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Alain Chichom-Mefire
- Faculty of Health Sciences, Department of Surgery, University of Buea, Buea, Cameroon
| | - Salomone Di Saverio
- General surgery 1st unit, Department of General Surgery, University of Insubria, Varese, Italy
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Mario Giuffrida
- Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Carlos Ordoñez
- Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | | | - Andrew Peitzman
- University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Manos Pikoulis
- 3rd Department of Surgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
| | | | - Vishal Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Edward Tan
- Department of Surgery, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo" Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
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Ohzu M, Takazawa H, Furukawa S, Komeno Y. Anorectal Abscess in a Patient with Neutropenia and Refractory Acute Myeloid Leukemia: To Operate or not to Operate? AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931589. [PMID: 34218249 PMCID: PMC8274364 DOI: 10.12659/ajcr.931589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anorectal infections occur in 5% to 9% of patients with hematological malignancies, including acute myeloid leukemia, and cause febrile neutropenia and sepsis. Surgical treatments of anorectal abscesses tend to be avoided in patients with leukemia owing to persistent neutropenia and bleeding risks. CASE REPORT A 56-year-old man presented with an ischiorectal abscess. Preoperative laboratory test results revealed leukocytopenia and anemia. He was diagnosed with acute myeloid leukemia. He developed septic shock. Antibiotic treatment was ineffective, and fever persisted. One week later, the abscess was treated by incision and drainage. Two days later, induction chemotherapy was initiated. No pus was drained; cellulitis spread to both buttocks. Pain worsened, and oxycodone was administered. Achievement of complete remission failed. Reinduction therapy was started, followed by fistulotomy of the abscess with extensive debridement of cellulitis on day 6. Granulation was observed on day 17. The patient's fever resolved on day 21. Although hematopoietic recovery was observed, bone marrow examination demonstrated partial remission. Two additional courses of chemotherapy were administered. Abscess recurrence was not observed, even during febrile neutropenia. The surgical wound shrank to a skin defect along the gluteal cleft. He achieved complete remission and was transferred to another hospital, where he underwent 3 allogeneic stem cell transplants. He died of leukemia progression. CONCLUSIONS Surgical treatments can prevent fatal progression of anorectal abscess, even during neutropenia. Incision and drainage are suitable for fluctuant abscesses. For a non-fluctuant abscess aggravated by sepsis and cellulitis, it is worth considering more invasive surgical interventions, including debridement and fistulotomy.
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Affiliation(s)
- Masami Ohzu
- Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Shinjuku City, Tokyo, Japan.,Department of Hematology and Oncology, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Hitomi Takazawa
- Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Shinjuku City, Tokyo, Japan.,Department of Internal Medicine, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Shinjuku City, Tokyo, Japan
| | - Satomi Furukawa
- Department of Coloproctology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Shinjuku City, Tokyo, Japan
| | - Yukiko Komeno
- Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Shinjuku City, Tokyo, Japan
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Abstract
Abstract
Background Human bone marrow transplantation (BMT) becomes an accepted treatment of leukemia, aplastic anemia, immunodeficiency syndromes, and hematologic malignancies. Colorectal surgeons must know how to determine and manage the main colonic complications.
Objective To review the clinical features, clinical and pathological staging of graft vs host disease (GVHD), and treatment of patients suffering with colonic complications of human bone marrow transplantation.
Patients and methods We have reviewed the records of all patients that received an allogeneic bone marrow transplant and were evaluated at our Colon and Rectal Surgery department due to gastrointestinal symptoms, between January 2007 and January 2012. The study was carried out in patients who developed colonic complications, all of them with clinical, histopathological or laboratory diagnosis.
Results The study group was constituted by 77 patients, 43 male and 34 female patients. We identified colonic complications in 30 patients (38.9%); five patients developed intestinal toxicity due to pretransplant chemotherapy (6.4%); graft vs. host disease was present in 16 patients (20%); 13 patients (16.8%) developed acute colonic GVHD, and 3 (3.8%) chronic GVHD. Infection was identified in 9 patients (11.6%).
Conclusions The three principal colonic complications are the chemotherapy toxicity, GVHD, and superinfection; the onset of symptoms could help to suspect the type of complication (0–20 day chemotherapy toxicity, 20 and more GVHD), and infection could appear in any time of transplantation.
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Perazzoli C, Feitosa MR, Figueiredo-Pontes LLD, da Rocha JJR, Simões BP, Féres O. Management of acute colorectal diseases in febrile neutropenic patients. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2014.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AbstractPatients 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.
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Affiliation(s)
- Camila Perazzoli
- Division of Coloproctology, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Marley Ribeiro Feitosa
- Division of Coloproctology, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Lorena Lobo de Figueiredo-Pontes
- Division of Hematology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - José Joaquim Ribeiro da Rocha
- Division of Coloproctology, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Belinda Pinto Simões
- Division of Hematology, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Omar Féres
- Division of Coloproctology, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
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7
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Ashkar C, Britto M, Carne P, Cheung W, Mirbagheri N. Perianal sepsis in neutropaenic patients with haematological malignancies: the role of magnetic resonance imaging and surgery. ANZ J Surg 2020; 90:1642-1646. [PMID: 32072724 DOI: 10.1111/ans.15744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/12/2020] [Accepted: 01/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perianal sepsis occurs in up to 10% of neutropaenic patients with haematological malignancy and is associated with significant morbidity and mortality. The management of this condition is challenging in neutropaenic patients due to its atypical pathophysiology. The aim of this study is to assess the role of magnetic resonance imaging (MRI) and surgery in neutropaenic patients with perianal sepsis. METHODS A retrospective chart review was performed on all neutropenic patients with a haematological malignancy who had a diagnosis of perianal sepsis during the inpatient admission between 2008 and 2017. Patient characteristics, symptoms, haematological data, MRI result, surgical intervention, intraoperative findings and outcomes including recurrence and mortality were collected. RESULTS Nineteen neutropaenic patients with haematological malignancy were treated for perianal sepsis, eight (42%) patients were managed conservatively and 11 (58%) were managed surgically. Nine patients underwent MRI, which identified a collection in 88% of cases despite severe neutropaenia. In patients with a collection identified on MRI prior to surgery, 80% had a drainable collection confirmed intraoperatively. Post-operative complications included two cases of sepsis from a presumed perianal source and one death. A total of 82% of patients experienced symptom resolution after surgery compared to 88% of patients managed conservatively. CONCLUSION This study has demonstrated that MRI is a useful diagnostic tool in evaluating perianal sepsis in patients with haematological malignancy, even during periods of severe neutropenia. We found that both conservative and surgical management strategies lead to resolution of symptoms.
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Affiliation(s)
- Claudia Ashkar
- Colorectal Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Maneka Britto
- Colorectal Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Carne
- Colorectal Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Wa Cheung
- Radiology Department, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Naseem Mirbagheri
- Department of Surgery, Eastern Health, Melbourne, Victoria, Australia
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8
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Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, Piloni V. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol 2020; 24:127-143. [DOI: 14) evaluation and management of perianal abscess and anal fistula: siccr position statement.a.amato, c.bottini, p.de nardi, p.giamundo, a.lauretta, a.realis luc & v.piloni.tech coloproctol 2020 24:127-143 doi 10.1007/s10151-019-02144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/23/2019] [Indexed: 09/10/2023]
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9
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Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol 2020; 24:127-143. [PMID: 31974827 DOI: 10.1007/s10151-019-02144-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. Surgery is the main treatment and several procedures have been developed, but the risks of recurrence and of impairment of continence still seem to be an unresolved issue. This statement reviews the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.
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10
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Renzi S, Bartram J, Ali S, Portwine C, Mitchell D, Dix D, Lewis V, Price V, Johnston DL, Sung L. Perianal Infections in Children With Acute Myeloid Leukemia: A Report From the Canadian Infection in Acute Myeloid Leukemia Research Group. J Pediatric Infect Dis Soc 2019; 8:354-357. [PMID: 30165563 DOI: 10.1093/jpids/piy081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/05/2018] [Indexed: 11/15/2022]
Abstract
Among 235 children with acute myeloid leukemia, 17 experienced 19 perianal infections. Among 12 episodes with definite abscess, 75% were severely neutropenic. Sixteen diagnostic imaging evaluations were performed; diagnostic yield was similar between computerized tomography of pelvis (5 of 10) and ultrasound (3 of 5). Consistent management approaches to perianal infection should be developed.
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Affiliation(s)
- Samuele Renzi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Jack Bartram
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Salah Ali
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Carol Portwine
- Hematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - David Mitchell
- Hematology/Oncology, Montreal Children's Hospital, Canada
| | - David Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - Victor Lewis
- Hematology/Oncology/Transplant Program, Alberta Children's Hospital, Calgary, Canada
| | - Victoria Price
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
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11
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Mo XD, Yan X, Hu W, Zhang XH, Xu LP, Wang Y, Xu XD, Wang LN, He XX, Yan CH, Chen H, Chen YH, Liu KY, Huang XJ. Perianal Infections in the Phase before Engraftment after Allogeneic Hematopoietic Stem Cell Transplantations: A Study of the Incidence, Risk Factors, and Clinical Outcomes. Acta Haematol 2018; 139:19-27. [PMID: 29320771 DOI: 10.1159/000481723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022]
Abstract
In this study, we aimed to investigate the incidence, risk factors, and clinical outcomes of perianal infections during the pre-engraftment phase after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Consecutive patients who underwent non-T-cell-depleted allo-HSCT at the Peking University Institute of Hematology from January 1 to December 31, 2016 were enrolled (n = 646). Ninety-nine patients were found to have perianal infections during the pre-engraftment phase, and 80 were found to have neutropenia on perianal infection diagnosis. The cumulative incidence of perianal infection during the pre-engraftment phase after allo-HSCT was 15.3%. A history of perianal infection (hazard ratio [HR] = 15.28, p < 0.001) or hemorrhoids before allo-HSCT (HR = 3.09, p = 0.001) was significantly associated with the new occurrence of perianal infection after allo-HSCT. All patients received empirical broad-spectrum antimicrobial therapies, and 97 were cured after treatment. The clinical outcomes at 100 days after allo-HSCT were comparable in patients with and without perianal infections. In summary, patients who had perianal infection or hemorrhoids before allo-HSCT had a higher risk of new occurrence of perianal infection after allo-HSCT. With appropriate treatment, perianal infection during the pre-engraftment phase did not influence the clinical outcomes.
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Affiliation(s)
- Xiao-Dong Mo
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
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Chang H, Kuo MC, Tang TC, Lin TL, Wu JH, Hung YS, Wang PN. Clinical Features and Recurrence Pattern of Perianal Abscess in Patients with Acute Myeloid Leukemia. Acta Haematol 2017; 138:10-13. [PMID: 28586772 DOI: 10.1159/000475589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/10/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Perianal abscess may develop during neutropenia periods in patients with acute myeloid leukemia (AML). The standard of care for perianal abscess in AML is unclear. METHODS We retrospectively collected patient data in our institute from 2009 to 2012. RESULTS Two hundred ninety-two patients with AML were analyzed. In total, 1,051 chemotherapy sessions were administered. Twenty-three patients experienced perianal abscess. Patients with perianal abscess were younger than those without (44 vs. 60 years, p < 0.0001). Perianal abscess developed in various phases of treatment and in the stem cell transplantation period. Twelve recurrences developed in 6 patients. Patients with a prior perianal abscess have a 10-fold risk of developing a subsequent abscess following further chemotherapy. The microbiology profile revealed that most pathogens were derived from the intestinal tracts, which was similar to the findings of previous studies. The 28-day mortality was 14.3% and the direct cause of death was not perianal abscess in any case. Surgical interventions had no impact on recurrence or survival. CONCLUSION In patients with AML, perianal abscess results from gastrointestinal tract pathogens. Many patients do not require surgical interventions. The mortality is low but recurrence is common following subsequent chemotherapies. Therefore, awareness of recurrence is important for the timely management of perianal abscess in AML.
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Affiliation(s)
- Hung Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital, Kweishan, Taiwan
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Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum 2016; 59:1117-1133. [PMID: 27824697 DOI: 10.1097/dcr.0000000000000733] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2015; 19:595-606. [PMID: 26377581 DOI: 10.1007/s10151-015-1365-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/11/2015] [Indexed: 12/14/2022]
Abstract
Perianal sepsis is a common condition ranging from acute abscess to chronic fistula formation. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. The key to successful treatment is the eradication of the primary track. As surgery may lead to a disturbance of continence, several sphincter-preserving techniques have been developed. This consensus statement examines the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.
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Cioli VM, Gagliardi G, Pescatori M. Psychological stress in patients with anal fistula. Int J Colorectal Dis 2015; 30:1123-9. [PMID: 25976930 DOI: 10.1007/s00384-015-2245-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 02/04/2023]
Abstract
AIM Psychological stress is known to affect the immunologic system and the inflammatory response. The aim of this study was to assess the presence of psychological stress, anxiety, and depression in patients with anal fistula. METHODS Consecutive patients with anal fistula, hemorrhoids, and normal volunteers were studied prospectively. Stressful life events were recorded and subjects were asked to complete the state-trait anxiety inventory (STAI), a depression scale, and three different reactive graphic tests (RGT). RESULTS Seventy-eight fistula patients, 73 patients with grade III-IV hemorrhoids, and 37 normal volunteers were enrolled. Of the fistula patients, 65 (83 %) reported one or more stressful events in the year prior to diagnosis, compared to 16 (22 %) of the hemorrhoid patients (P = 0.001). There were no significant differences in the percentage of subjects with abnormal trait anxiety (i.e., proneness for anxiety) and depression scores between fistula patients, hemorrhoid patients, and controls. Fistula patients had significantly higher (i.e., better) scores compared to hemorrhoid patients in two of three RGT and significantly lower (i.e., worse) scores in all three RGT compared to healthy volunteers. Of 37 patients followed up for a median of 28 months (range 19-41 months) after surgery, 8 (21.6 %) had persistent or recurrent sepsis. There was no significant difference in depression, STAI, and RGT scores between patients with sepsis and patients whose fistula healed. CONCLUSION Our results suggest that an altered emotional state plays an important role in the pathogenesis of anal fistula and underline the importance of psychological screening in patients with anorectal disorders.
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Affiliation(s)
- V M Cioli
- Coloproctology Unit, Parioli Clinic, Rome, Italy
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Management of acute perianal sepsis in neutropenic patients with hematological malignancy. Tech Coloproctol 2013; 18:327-33. [DOI: 10.1007/s10151-013-1082-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/13/2013] [Indexed: 01/06/2023]
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Wei PL, Keller JJ, Kuo LJ, Lin HC. Increased risk of diabetes following perianal abscess: a population-based follow-up study. Int J Colorectal Dis 2013; 28:235-40. [PMID: 22729713 DOI: 10.1007/s00384-012-1519-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE It remains unclear whether perianal abscess is a prediabetes condition or the initial presentation of type 2 diabetes. Using a population-based dataset, this study aimed to explore the risk of type 2 diabetes following perianal abscess. METHODS We used data sourced from the Longitudinal Health Insurance Database 2000. In total, there were 1,419 adult patients with perianal abscess in the study group and 7,095 randomly selected subjects in the comparison group. Stratified Cox proportional hazards regressions were carried out to evaluate the association between being diagnosed with perianal abscess and receiving a subsequent diagnosis of diabetes within 5 years. RESULTS Of the total 8,514 sampled subjects, the incidence rate of diabetes per 100 person-years was 1.87 (95 % confidence interval (CI) = 1.74-2.01); the rate among patients with perianal abscess was 3.00 (95 % CI = 2.60-3.43) and was 1.65 (95 % CI = 1.52-1.79) among comparison patients. Stratified Cox proportional hazards analysis revealed that patients with perianal abscess were more likely to have received a diagnosis of diabetes than comparison patients (hazard ratio = 1.80, 95 % CI = 1.50-2.16, p < 0.001) during the 5-year follow-up period after censoring cases that died from nondiabetes causes and adjusting for patient geographic location, urbanization level, monthly income, hypertension, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome at baseline. CONCLUSIONS Our results suggest that patients with perianal abscess have a higher chance of contracting type 2 diabetes mellitus within the first 5 years following their diagnosis.
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Affiliation(s)
- Po-Li Wei
- Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
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Morcos B, Amarin R, Abu Sba' A, Al-Ramahi R, Abu Alrub Z, Salhab M. Contemporary management of perianal conditions in febrile neutropenic patients. Eur J Surg Oncol 2013; 39:404-7. [PMID: 23347777 DOI: 10.1016/j.ejso.2013.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/11/2012] [Accepted: 01/09/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this study was to examine the type and frequency of perianal conditions in a contemporary series of febrile neutropenic patients and to examine the risk factors, management options and outcome of septic perianal conditions. METHODS Medical records of all adult febrile neutropenic patients (933 patients) who were admitted during the period from January, 2009 to December 2011 were retrospectively review. All patients with perianal complaints or conditions were included. The clinical features, management and outcome of septic conditions were recorded. RESULTS Of all the reviewed charts, 101 (10.8%) had perianal complaints or conditions. Most of them were non septic (74.3%), like piles and fissures, and were treated conservatively. In 26 patients the diagnosis was a septic condition: abscess (12 patients), fistula (4), inflammation (9) and necrotizing fasciitis (1). Septic conditions were more commonly found in males younger than 40 years. Surgery was done in 13 patients to drain a collection and in 2 patients to debride necrotic tissue. Most patients who had no collection had conservative management. There was 1 fatality only (3.8%) in those 26 patients. CONCLUSION Most of the perianal conditions in febrile neutropenic patients are non septic and are managed conservatively. Septic perianal conditions are not associated with a poor prognosis as in the past. Surgical drainage should be reserved to conditions where there is a collection; otherwise patients should be managed conservatively but with close monitoring.
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Affiliation(s)
- B Morcos
- Department of Surgery, King Hussein Cancer Center, P.O.Box 1269, Al-Jubeiha, Amman 11941, Jordan.
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Anabtawi I, Abdel-Rahman F, Al Masri M. Surgical complications related to hematopoietic stem cell transplantation. Eur J Surg Oncol 2011; 37:576-82. [PMID: 21420823 DOI: 10.1016/j.ejso.2011.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 12/19/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Surgical complications in recipients of hematopoietic stem cell transplantation (HSCT) are common. However, this issue is infrequently reported in the literature. METHODS The records of 165 patients who underwent hematopoietic stem cell transplantation at King Hussein Cancer Center between January 2007 and December 2008 were retrospectively reviewed. All surgical complications were included and were classified into gastrointestinal (GI), catheter-related, ear, nose and throat (ENT), peri anal, musculoskeletal, neurological and urological complications. RESULTS There were 279 surgical complications in the studied patients. Gastrointestinal (n = 122) and catheter-related (n = 78) complications were the most frequent. The frequency and the percentage of patients needing surgical intervention for the 5 most common complications were as follows: Gastrointestinal (n = 122, 4.5% needed surgical intervention), catheter-related (n = 78, 46.2%), ear, nose and throat (n = 31, 9.7%), perianal disease (n = 21, 19%) and urinary complications (n = 17, 5.9%). Surgical consultation was sought for 116 surgical complications. Surgical interventions were necessary for 55 patients. All the patients who underwent surgery did not have an intervention-related mortality except for one patient who died from surgical intervention post-gastrointestinal complication. CONCLUSION The majority of surgical complications after HSCT do not require surgical intervention. However, these conditions may overlap with the more common reasons for surgical consultation and must be identifiable by the surgeon. Extra vigilance is necessary when dealing with both GI and catheter-related complications as they are the most frequent. The early involvement of surgeons and proper timing of surgical management may circumvent detrimental outcomes.
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Affiliation(s)
- I Anabtawi
- Department of Surgery, King Hussein Cancer Center, Queen Rania Street, PO Box 1269, Al-Jubeiha, Amman 11941, Jordan
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Badgwell BD, Chang GJ, Rodriguez-Bigas MA, Smith K, Lupo PJ, Frankowski RF, Delclos G, Du XL, Cormier J. Management and Outcomes of Anorectal Infection in the Cancer Patient. Ann Surg Oncol 2009; 16:2752-8. [DOI: 10.1245/s10434-009-0626-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 06/26/2009] [Accepted: 06/27/2009] [Indexed: 11/18/2022]
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Surgical Emergencies. Oncology 2007. [DOI: 10.1007/0-387-31056-8_73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rolston KVI, Bodey GP, Safdar A. Polymicrobial Infection in Patients with Cancer: An Underappreciated and Underreported Entity. Clin Infect Dis 2007; 45:228-33. [PMID: 17578784 DOI: 10.1086/518873] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 03/24/2007] [Indexed: 12/30/2022] Open
Abstract
Polymicrobial infections account for ~15% of infections in immunocompromised patients with cancer. However, limited information exists regarding the spectrum and microbiology of these infections, even in severely neutropenic patients. Most studies describe only monomicrobial bloodstream infections in detail, and information regarding polymicrobial infections and nonbacteremic infections is often incomplete or not provided at all. The current lack of well-established definitions for various infections in the immunocompromised host, including pneumonia, neutropenic enterocolitis, and polymicrobial infections, probably plays an important role in the paucity of published information. In this review, we briefly describe the limited information available regarding polymicrobial infections in patients with cancer and address the need for establishing consensus definitions for site-specific polymicrobial infections in neutropenic and nonneutropenic patients. We anticipate that, as factual information regarding such infections becomes available, a more comprehensive understanding of the true scope and impact of these infections will emerge, leading to appropriate modifications in the diagnostic work-up and in the therapeutic approaches used in treating these patients.
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Affiliation(s)
- Kenneth V I Rolston
- The University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Chaar BT, Kudva GC, Frey S, Wolverson MK. A rod in the spine. Am J Med 2006; 119:1045-7. [PMID: 17145248 DOI: 10.1016/j.amjmed.2006.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 10/03/2006] [Accepted: 10/03/2006] [Indexed: 11/26/2022]
Affiliation(s)
- Bassem T Chaar
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Mo, USA
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Hohenberger P, Buchheidt D. Surgical interventions in patients with hematologic malignancies. Crit Rev Oncol Hematol 2005; 55:83-91. [PMID: 15886009 DOI: 10.1016/j.critrevonc.2005.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Revised: 02/25/2005] [Accepted: 03/11/2005] [Indexed: 11/27/2022] Open
Abstract
While surgery is not a part of treatment of hematological malignancies a significant number of patients suffering from such diseases need to undergo surgical interventions. These may comprise of very minor procedures such port implantation, however, already the indication for appendicectomy could be a difficult scenario being influenced by the underlying disease and side effects of the treatment. Often septic foci need to be cleared prior to start of systemic treatment. Out of the really major problems, the surgical resection of aspergillomas represent a demanding task accompanied by significant morbidity and mortality. Emergency situations sometimes are induced by treatment such as necrotizing enterocolitis but sometimes are mimicked by drug-induced abdominal symptoms. An experienced team of surgical and medical oncologists is required for successful management. As the number of long-term surviving patients increases, secondary problems as aseptic bone necrosis need to be addressed and adequately handled. Even at this stage it might be difficult to assess the patients risk for open-heart surgery adequately. This group of patients if scheduled for any operative intervention needs to undergo a very careful selection process and perfect perioperative management to make sure that the result of surgery are excellent and do not compromise further medical treatment of the underlying disease.
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Affiliation(s)
- Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany.
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