Management of anorectal and intra-abdominal infections in the neutropenic cancer patient

Abstract

Anorectal infection in the neutropenic cancer patient is a significant and potentially fatal complication in patients receiving systemic chemotherapy. The diagnosis is often made clinically on the basis of signs and symptoms (perianal pain, erythema, and tenderness), after surgical drainage of an abscess, or from cross-sectional imaging demonstrating perianal inflammation, fluid collection, or fistula formation. The management of these patients is not straightforward, and the literature continues to be unclear about the indications for and timing of surgical intervention. In the immunocompetent patient, the management is well defined, often including an examination under anesthesia and drainage if an abscess is present. The patient with neutropenia, thrombocytopenia, and perianal disease receiving chemotherapy for malignancy presents the clinician with unique circumstances that often affect management strategy. In a multidisciplinary fashion, the treating team must consider factors such as recent chemotherapy toxicity, stage and prognosis of malignancy, performance status, comorbidities, neutropenia, immunosuppression, thrombocytopenia, and steroid use. These unique features highlight the difference between anorectal infection in patients with neutropenic cancer and anorectal infection found in the general population. Early reports of patients with neutropenia and perianal infection indicate mortality rates as high as 50%.