Contemporary management of perianal conditions in febrile neutropenic patients.
BACKGROUND
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.


CONCLUSIONS
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.
Department of Surgery, King Hussein Cancer Center, P.O.Box 1269, Al-Jubeiha, Amman 11941, Jordan. bmorcos@doctor.com
B
B
Morcos
R
R
Amarin
A
A
Abu Sba'
R
R
Al-Ramahi
Z
Z
Abu Alrub
M
M
Salhab
D000038:Abscess / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001004:Anus Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007597:Jordan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D012003:Rectal Fistula / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*
D000970:Antineoplastic Agents