Perianal sepsis in neutropaenic patients with haematological malignancies: the role of magnetic resonance imaging and surgery
| Autor: | Wa Cheung, Maneka M. Britto, Peter Carne, Claudia Ashkar, Naseem Mirbagheri |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Perianal sepsis Patient characteristics Sepsis 03 medical and health sciences 0302 clinical medicine medicine Humans In patient Severe neutropenia Retrospective Studies Anus Diseases medicine.diagnostic_test business.industry Magnetic resonance imaging General Medicine medicine.disease Magnetic Resonance Imaging Pathophysiology Surgery 030220 oncology & carcinogenesis Hematologic Neoplasms 030211 gastroenterology & hepatology Neoplasm Recurrence Local business Haematological malignancy |
| Zdroj: | ANZ journal of surgeryReferences. 90(9) |
| ISSN: | 1445-2197 |
| Popis: | BACKGROUND Perianal sepsis occurs in up to 10% of neutropaenic patients with haematological malignancy and is associated with significant morbidity and mortality. The management of this condition is challenging in neutropaenic patients due to its atypical pathophysiology. The aim of this study is to assess the role of magnetic resonance imaging (MRI) and surgery in neutropaenic patients with perianal sepsis. METHODS A retrospective chart review was performed on all neutropenic patients with a haematological malignancy who had a diagnosis of perianal sepsis during the inpatient admission between 2008 and 2017. Patient characteristics, symptoms, haematological data, MRI result, surgical intervention, intraoperative findings and outcomes including recurrence and mortality were collected. RESULTS Nineteen neutropaenic patients with haematological malignancy were treated for perianal sepsis, eight (42%) patients were managed conservatively and 11 (58%) were managed surgically. Nine patients underwent MRI, which identified a collection in 88% of cases despite severe neutropaenia. In patients with a collection identified on MRI prior to surgery, 80% had a drainable collection confirmed intraoperatively. Post-operative complications included two cases of sepsis from a presumed perianal source and one death. A total of 82% of patients experienced symptom resolution after surgery compared to 88% of patients managed conservatively. CONCLUSION This study has demonstrated that MRI is a useful diagnostic tool in evaluating perianal sepsis in patients with haematological malignancy, even during periods of severe neutropenia. We found that both conservative and surgical management strategies lead to resolution of symptoms. |
| Databáze: | OpenAIRE |
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