Diagnostics and treatment of complicated perianal abscess in patients with hematologic malignancies

AIM: to work out an algorithm for diagnosis and tactics of treatment of complicated perianal abscess (CPA) in oncohematology.

PATIENTS AND METHODS: the cohort study (January 2021 — December 2022) included 78 patients with hematologic malignancies and infectious lesions of the perianal soft tissues. Complex perianal infection (CPI) was distinguished in the presence of supralevator abscess, pelvic phlegmon, destruction of the rectal wall above the level of the dentate line, and pelvic organs involvement. The correspondence of clinical, laboratory data and MRI results, as well as the results of surgical drainage, antibacterial therapy, and vacuum therapy were assessed.

RESULTS: CPI was detected in 7 (8.97%) patients with perianal infection. The neutropenia was detected in all patients (neutrophils < 500 × 109/l); no fever occurred in two patients. Clinical data were adjusted after MRI results in 6 (85.7%) cases. Pelviorectal abscesses were noted in 5 patients, in 2 — pelvic phlegmon was detected. In addition, 2 patients revealed perforation of the rectum above the dentate line, 1 — rectovaginal fistula. Due to sepsis, 4 (57.14%) patients were in the intensive care unit, the period in the intensive care unit was 32.5 (17–54) days. Abscess drainage was performed in all patients, in 3 cases — diverting sigmostomy. The wound repair phase was achieved in all patients. The time of reparation was 79 (37–142) days. Vacuum therapy was used in 2 cases with wound repair time of 53.5 days. Postoperatively, febrile fever with periods of normothermia for 1 month was revealed in all cases. Two patients died within 50 and 215 days from causes unrelated to perianal abscess.

CONCLUSION: pelvic MRI is a preferable diagnostic test to determine the volume of lesion in CPI in patients with hematological malignancies. CPI in patients with neutropenia is associated with a high incidence of sepsis. The main methods of infection control are abscess drainage and antibacterial therapy, which should be started before surgery and continued in the postoperative period until normothermia and regression of local signs of inflammation. Vacuum therapy is a safe and effective method in treatment of big postoperative wounds in patients with neutropenia.

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