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

Yıl 2018, Cilt: 10 Sayı: 4, 454 - 459, 01.12.2018
https://doi.org/10.21601/ortadogutipdergisi.412212

Öz

Aim: Perianal
infection is one of the most important causes of infection in acute leukemia
which puts the life of patients at risk, increases their morbidity and impairs
quality of life.

Material and Method: At
the Ankara Atatürk Training and Research Hospital Hematology Clinic, 125
patients who received standard chemotherapy for acute leukemia between 2009 and
2017 werestudied, retrospectively.

Results
Of
these 125 acute leukemia patients, 25(20%) developed perianal disease and
13(10.4%) developed perianal infection. Perianal disease and infection
developed in 34% and 21% of patients with ALL ; in 16% and 7% of patients with
AML (p = 0.03 and p=0.04), respectively. 
Perianal disease was present in 29% of the patients with a leukocyte
count greater than 10,000 at diagnosis, but remained at 12% in those with a
leukocyte count below 10,000 (p = 0.02). Perianal disease and perianal
infection developed in 64% and 69% of the patients during induction and  at a median of 13 days (range: 1-40) and 17
days (range: 3-34), respectively. It was observed that 60% of the patients with
perianal disease had fever, 28% had positive blood culture, 16% had sepsis and
20% required surgical treatment.  Among 7
patients with perianal disease and positive blood cultures, all had gram (-)
bacilli (5 Klebsiella pneumonia and 2
E. Coli). Of the 6 patients who had
masses in physical examination under went pelvic magnetic resonance imaging
(MRI). All patients diagnosed with abscesses on MRI. Five patients who under
went surgery; 3 abscess drainage, 1 colostomy and 1 polypectomy was performed.









Conclusion: It was observed that perianal disease and infection
developed more frequently in ALL patients compared with AML patients; perianal
disease could be controlled mainly with conservative treatment and MRI could be
an important guide in the management of these patients

Kaynakça

  • 1. Paul M, Gafter-Gvili A, Goldberg E, Yahav D (2011) Infections in hematogical cancer patients: the contribution of systematic reviews and meta-analyses. Acta Haematol. 125: 80–90., 2. Chen CY, Tsay W, Tang JL, Tien HF, Chen YC, et al. (2010) Epidemiology of bloodstream infections in patients with haematological malignancies with and without neutropenia. Epidemiol Infect. 138: 1044–51.).3. Vanhueverzwyn R, Delannoy A, Michaux JL, Dive C (1980) Anal lesions in hematologic diseases. Dis Colon Rectum. 23: 310–2., 4. Barnes SG, Sattler FR, Ballard JO (1984) Perirectal infections in acute leukemia. Improved survival after incision and debridement. Ann Intern Med. 100: 515–8., 5. Pini Prato A, Castagnola E, Micalizzi C, Dufour C, Avanzini S, et al. (2012) Early diverting colostomy for perianal sepsis in children with acute leukemia. J Pediatr Surg. 47: e23–7., 6. Spasova MI, Grudeva-Popova JG, Kostyanev SS, Genev ED, Stoyanova AA, et al. (2009) Risk index score for bacteremia in febrile neutropenic episodes in children with malignancies. J BUON. 14: 411–8.).7. Nada EM, Alshoaiby AN, Alaskar AS, Khan AN (2007) Severe anal and abdominal pain due to typhlitis in a leukemic patient. J Pain Symptom Manage. 34: 457–9.8. Slater DN (1984) Perianal abscess: "Have I excluded leukaemia"? Br Med J (Clin Res Ed). 289: 1682., 9. Buyukasik Y, Ozcebe OI, Sayinalp N, Haznedarogˇlu IC, Altundagˇ OO, et al. (1998) Ozdemir O, Dundar S. Perianal infections in patients with leukemia:importance of the course of neutrophil count. Dis Colon Rectum. 41: 81–5., 10. Papaconstantinou I, Yiallourou AI, Dafnios N, Grapsa I, Polymeneas G, Voros D (2011) Successful treatment of a severe case of Fournier’s gangrene complicating a perianal abscess. Case Rep Med 2011:702429).11. Badgwell BD, Chang GJ, Rodriguez-Bigas MA et al (2009) Management and outcomes of anorectal infection in the cancer patient. Ann Surg Oncol 16:2752–2758).12. Schimpff SC, Wiernik PH, Block JB (1972) Rectal abscesses in cancer patients. Lancet 2:844–847. 13. Musa MB, Katakkar SB, Khaliq A (1975) Anorectal and perianal complications of hematologic malignant neoplasms. Can J Surg 18:579–583).14. Merrill JM, Brereton HD, Kent CH, Johnson RE (1976) Anorectal disease in patients with non-haematological malignancy. Lancet 1:1105–1107.15. North JH Jr, Weber TK, Rodriguez-Bigas MA, Meropol NJ, Petrelli NJ (1996) The management of infectious and noninfectious anorectal complications in patients with leukemia. J Am Coll Surg. 183: 322–8., 16. Schubert MC, Sridhar S, Schade RR, Wexner SD (2009) What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol.15: 3201-9., 17. Rizzo JA, Naig AL, Johnson EK (2010) Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin North Am. 90: 45–68., 18. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg. 63: 1–12.).19. Bodey GP (2000) Unusual presentations of infection in neutropenic patients. Int J Antimicrob Agents. 16:93–5).20. Sharma A, Lokeshwar N. Febrile neutropenia in haematological malignancies. J Postgrad Med. 2005;51 Suppl 1:S42-8.21. Chirletti P, Beverati M, Apice N et al (1988) Prophylaxis and treatment of inflammatory anorectal complications in leukemia. Ital J Surg Sci 18:45–48.22. Boddie AW Jr, Bines SD (1986) Management of acute rectal problems in leukemic patients. J Surg Oncol. 33: 53–6., 23. Carlson GW, Ferguson CM, Amerson JR (1988) Perianal infections in acute leukemia. Second place winner: conrad Jobst Award. Am Surg 54:693–695, 24. Grewal H, Guillem JG, Quan SH, Enker WE, Cohen AM (1994) Anorectal disease in neutropenic leukemic patients. Operative vs. nonoperative management. Dis Colon Rectum 37:1095–1099, 25. Lehrnbecher T, Marshall D, Gao C, Chanock SJ (2002) A second look at anorectal infections in cancer patients in a large cancer institute: the success of early intervention with antibiotics and surgery. Infection 30:272–276, 26. Glenn J, Cotton D, Wesley R, Pizzo P (1988) Anorectal infections in patients with malignant diseases. Rev Infect Dis 10:42–52.27. Hebjørn M, Olsen O, Haakansson T, Andersen B (1987) A randomized trial of fistulotomy in perianal abscess. Scand J Gastroenterol 22:174–176).28. R L, Pj L, Tm H (2012) Novel biological strategies in the management of anal fistula. Colorectal Dis. 14:1445–55., 29. O’Riordan JM, Datta I, Johnston C, Baxter NN (2012) A systematic review of the anal fistula plug for patients with Crohn’s and non-Crohn’s related fistula-in-ano. Dis Colon Rectum. 55: 351–8.).30. Liu CK, Liu CP, Leung CH, Sun FJ (2011) Clinical and microbiological analysis of adult perianal abscess. J Microbiol Immunol Infect. 44: 204–8., 31. Eykyn SJ, Grace RH (1986) The relevance of microbiology in the management of anorectal sepsis. Ann R Coll Surg Engl. 68: 237–9.).32. Siddiqui MR, Ashrafian H, Tozer P, Daulatzai N, Burling D, et al. (2012) A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 55: 576–85., 33. George U, Sahota A, Rathore S (2011) MRI in evaluation of perianal fistula. J Med Imaging Radiat Oncol. 55:391–400.).

Akut lösemili hastalarda perianal hastalıkların prevalansı ve güncel yönetimi

Yıl 2018, Cilt: 10 Sayı: 4, 454 - 459, 01.12.2018
https://doi.org/10.21601/ortadogutipdergisi.412212

Öz

Amaç: Perianal
enfeksiyon akut lösemi hastalarının sağkalımını tehlikeye atan, morbiditelerini
artıran ve yaşam kalitelerini bozan en önemli enfeksiyon nedenlerinden
birisidir.



Gereç ve Yöntem:
Ankara Atatürk Eğitim ve Araştırma Hastanesi Hematoloji Kliniği’nde 2009-2017
arasında akut lösemi nedeniyle standart kemoterapi tedavisi alan 125 hasta
geriye dönük olarak çalışmaya alındı.



Bulgular:
Bu 125 akut lösemi hastasının 25’inde perianal hastalık gelişmiş olup perianal
hastalık gelişim riski % 20 olarak saptandı. Perianal enfeksiyon ise 13 hastada
gelişirken perianal enfeksiyon gelişim riski % 10,4 olarak hesaplandı. ALL
tanılı hastaların %34’ünde ve AML tanılı hastaların %16’sında perianal hastalık
gelişti (p=0,03). Tanıdaki lökosit sayısı 10,000’in üzerinde olanların %29’unda
perianal hastalık gelişirken, bu oran lökosit sayısı 10,000’in altında
olanlarda %12’de kaldı (p=0,02). ALL hastaları arasında perianal enfeksiyon
gelişim riski %21 iken AML hastaları açısından risk %7 olarak saptandı (p=0,04)
(Tablo 2). Perianal hastalık gelişen hastaların %64’ünde perianal hastalığın
indüksiyon sırasında geri kalanında ise konsolidasyonda geliştiği ortanca
gelişme gününün 13 (aralık:1-40) olduğu gözlendi. Perianal hastalık gelişen
hastaların %60’ında ateş gözlendiği, %28’inde kan kültüründe üreme olduğu,
%16’sında sepsis geliştiği ve %20’sinde ilerleyen dönemde cerrahi tedavi
gerektiği gözlendi. Perianal enfeksiyon gelişimi açısından hastalar
incelendiğinde ise hastaların %69’unda enfeksiyonun indüksiyon sırasında
geliştiği ve ortanca gelişme gününün 17 (aralık:3-34) olduğu gözlendi. Perianal
enfeksiyon saptanan hastaların %62’sinde ateş gözlendiği, %46’sında kan
kültüründe üreme gözlendiği, hastaların %15’inde sepsis geliştiği ve hastaların
%23’ünün ilerleyen dönemde cerrahi tedavi yapıldığı gözlendi. Perianal
hastalığı olup kan kültüründe üremesi olan 7 hasta incelendiğinde tüm
hastalarda gram (-) basil ürediği bunların 5’inin Klebsiella Pnömonia ve 2’sinin E.
Coli olduğu gözlendi. Fizik incelemede abse saptanan ve MRG yapılan 6 hasta
mevcuttu. Tüm hastalarda MRG’de de abse olduğu gözlendi. Cerrahi girişim
yapılan 5 hastaya bakıldığında 3 hastada apse drenajı, 1 hastaya kolostomi
açılması yapıldığı, 1 hastaya da polipektomi yapıldığı saptandı.



Sonuç:
ALL hastalarında AML hastalarına göre daha fazla perianal hastalık ve
enfeksiyon geliştiği, perianal hastalığın konservatif tedavi ile büyük oranda
düzeltilebileceği ve MRG’nin bu hastaların yönetiminde yol gösterici
olabileceği gözlendi.

Kaynakça

  • 1. Paul M, Gafter-Gvili A, Goldberg E, Yahav D (2011) Infections in hematogical cancer patients: the contribution of systematic reviews and meta-analyses. Acta Haematol. 125: 80–90., 2. Chen CY, Tsay W, Tang JL, Tien HF, Chen YC, et al. (2010) Epidemiology of bloodstream infections in patients with haematological malignancies with and without neutropenia. Epidemiol Infect. 138: 1044–51.).3. Vanhueverzwyn R, Delannoy A, Michaux JL, Dive C (1980) Anal lesions in hematologic diseases. Dis Colon Rectum. 23: 310–2., 4. Barnes SG, Sattler FR, Ballard JO (1984) Perirectal infections in acute leukemia. Improved survival after incision and debridement. Ann Intern Med. 100: 515–8., 5. Pini Prato A, Castagnola E, Micalizzi C, Dufour C, Avanzini S, et al. (2012) Early diverting colostomy for perianal sepsis in children with acute leukemia. J Pediatr Surg. 47: e23–7., 6. Spasova MI, Grudeva-Popova JG, Kostyanev SS, Genev ED, Stoyanova AA, et al. (2009) Risk index score for bacteremia in febrile neutropenic episodes in children with malignancies. J BUON. 14: 411–8.).7. Nada EM, Alshoaiby AN, Alaskar AS, Khan AN (2007) Severe anal and abdominal pain due to typhlitis in a leukemic patient. J Pain Symptom Manage. 34: 457–9.8. Slater DN (1984) Perianal abscess: "Have I excluded leukaemia"? Br Med J (Clin Res Ed). 289: 1682., 9. Buyukasik Y, Ozcebe OI, Sayinalp N, Haznedarogˇlu IC, Altundagˇ OO, et al. (1998) Ozdemir O, Dundar S. Perianal infections in patients with leukemia:importance of the course of neutrophil count. Dis Colon Rectum. 41: 81–5., 10. Papaconstantinou I, Yiallourou AI, Dafnios N, Grapsa I, Polymeneas G, Voros D (2011) Successful treatment of a severe case of Fournier’s gangrene complicating a perianal abscess. Case Rep Med 2011:702429).11. Badgwell BD, Chang GJ, Rodriguez-Bigas MA et al (2009) Management and outcomes of anorectal infection in the cancer patient. Ann Surg Oncol 16:2752–2758).12. Schimpff SC, Wiernik PH, Block JB (1972) Rectal abscesses in cancer patients. Lancet 2:844–847. 13. Musa MB, Katakkar SB, Khaliq A (1975) Anorectal and perianal complications of hematologic malignant neoplasms. Can J Surg 18:579–583).14. Merrill JM, Brereton HD, Kent CH, Johnson RE (1976) Anorectal disease in patients with non-haematological malignancy. Lancet 1:1105–1107.15. North JH Jr, Weber TK, Rodriguez-Bigas MA, Meropol NJ, Petrelli NJ (1996) The management of infectious and noninfectious anorectal complications in patients with leukemia. J Am Coll Surg. 183: 322–8., 16. Schubert MC, Sridhar S, Schade RR, Wexner SD (2009) What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol.15: 3201-9., 17. Rizzo JA, Naig AL, Johnson EK (2010) Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin North Am. 90: 45–68., 18. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg. 63: 1–12.).19. Bodey GP (2000) Unusual presentations of infection in neutropenic patients. Int J Antimicrob Agents. 16:93–5).20. Sharma A, Lokeshwar N. Febrile neutropenia in haematological malignancies. J Postgrad Med. 2005;51 Suppl 1:S42-8.21. Chirletti P, Beverati M, Apice N et al (1988) Prophylaxis and treatment of inflammatory anorectal complications in leukemia. Ital J Surg Sci 18:45–48.22. Boddie AW Jr, Bines SD (1986) Management of acute rectal problems in leukemic patients. J Surg Oncol. 33: 53–6., 23. Carlson GW, Ferguson CM, Amerson JR (1988) Perianal infections in acute leukemia. Second place winner: conrad Jobst Award. Am Surg 54:693–695, 24. Grewal H, Guillem JG, Quan SH, Enker WE, Cohen AM (1994) Anorectal disease in neutropenic leukemic patients. Operative vs. nonoperative management. Dis Colon Rectum 37:1095–1099, 25. Lehrnbecher T, Marshall D, Gao C, Chanock SJ (2002) A second look at anorectal infections in cancer patients in a large cancer institute: the success of early intervention with antibiotics and surgery. Infection 30:272–276, 26. Glenn J, Cotton D, Wesley R, Pizzo P (1988) Anorectal infections in patients with malignant diseases. Rev Infect Dis 10:42–52.27. Hebjørn M, Olsen O, Haakansson T, Andersen B (1987) A randomized trial of fistulotomy in perianal abscess. Scand J Gastroenterol 22:174–176).28. R L, Pj L, Tm H (2012) Novel biological strategies in the management of anal fistula. Colorectal Dis. 14:1445–55., 29. O’Riordan JM, Datta I, Johnston C, Baxter NN (2012) A systematic review of the anal fistula plug for patients with Crohn’s and non-Crohn’s related fistula-in-ano. Dis Colon Rectum. 55: 351–8.).30. Liu CK, Liu CP, Leung CH, Sun FJ (2011) Clinical and microbiological analysis of adult perianal abscess. J Microbiol Immunol Infect. 44: 204–8., 31. Eykyn SJ, Grace RH (1986) The relevance of microbiology in the management of anorectal sepsis. Ann R Coll Surg Engl. 68: 237–9.).32. Siddiqui MR, Ashrafian H, Tozer P, Daulatzai N, Burling D, et al. (2012) A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 55: 576–85., 33. George U, Sahota A, Rathore S (2011) MRI in evaluation of perianal fistula. J Med Imaging Radiat Oncol. 55:391–400.).
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

Mehmet Gündüz

Şule Mine Bakanay Bu kişi benim

Samet Yaman Bu kişi benim

Ahmet Usta Bu kişi benim

Mehmet Özen

Aysun Şentürk Yıkılmaz Bu kişi benim

Selin Küçükyurt Kaya Bu kişi benim

Servihan Doğan Bu kişi benim

Sema Akıncı Bu kişi benim

İmdat Dilek

Yayımlanma Tarihi 1 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 10 Sayı: 4

Kaynak Göster

Vancouver Gündüz M, Bakanay ŞM, Yaman S, Usta A, Özen M, Şentürk Yıkılmaz A, Küçükyurt Kaya S, Doğan S, Akıncı S, Dilek İ. Akut lösemili hastalarda perianal hastalıkların prevalansı ve güncel yönetimi. otd. 2018;10(4):454-9.

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