Surgical Treatment of Perianal Infectious Complications in Hematologic Clinic

SURGICAL COMPLICATIONS IN ONCOHEMATOLOGY , , , ,

S.V. Shtyrkova, S.R. Karagyulyan, K.I. Danishyan, S.K. Kravchenko, V.V. Troitskaya, L.A. Kuz’mina

Hematology Research Center under the Ministry of Health of the Russian Federation, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167

For correspondence: Svetlana Vital’evna Shtyrkova, PhD, 4а Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; Tel.: +7(495)612-61-91; e-mail: sv-styrkova@mail.ru

For citation: Shtyrkova S.V., Karagyulyan S.R., Danishyan K.I., Kravchenko S.K., Troitskaya V.V., Kuz’mina L.A. Klin. Onkogematol. 2015; 8(3): 337-42. (In Russ.)

ABSTRACT

Background & Aims. In general surgical practice, the perianal infection is considered an emergency surgical defect and requires an urgent surgical intervention. However, the perianal infection complicating leukemia has its peculiar clinical manifestations and requires revision of the traditional approach. The aim of the study is to mark out possible risk factors of development of the perianal infection in patients with hematologic malignancy and to estimate efficacy of various treatment options.

Methods. Results of examination and treatment of 143 oncohematological patients with inflammatory anorectal pathology are presented. Among them, the largest group consisted of 110 patients with anal fissures and fistulas.

Results. The study demonstrated that the main mechanism of infection in these patients was associated with local damage of the wall of the anal canal: mechanical trauma ® crack ® paraproctitis or inflammation due to diarrhea or toxic effects of drugs ® anusitis ® cryptitis ® paraproctitis. In case of paraproctitis in patients with leukopenia, a combined parenteral antibiotic therapy is considered to be the basic treatment method.

Conclusion. In oncohematological patients when the underlying disease as well as the upcoming chemotherapy can lead to severe immunosuppression, the presence of persistent defect of the anal canal wall (anal fissure, fistula) should be considered as an indication for surgery. The surgical procedure reduces the risk of local inflammation and septic complications.

Keywords: perianal infection, disease of the anal canal, hematologic malignancies, leukemia, chemotherapy.

Received: May 19, 2015

Accepted: June 3, 2015

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