Perianal sepsis and hematological patients: What to expect. A 5-year review

INTRODUCTION:

Hematological patients are related to immunosuppression treatments and a high morbi mortality is associated with this fact, and perianal sepsis is one of the plausible septic sources in these patients.

OBJECTIVE:

We want to describe our experience in the management of hematological patients with perianal sepsis.

METHODS:

We reviewed 5 years of the patients attended by our department, the review included patients with sepsis from perianal sepsis who were in hospital due to hematological disorders.

RESULTS:

We present a series of 24 patients ( 6 women and 18 males) with a mean of 54 years of age. The main symptoms were pain in 23 patients and fever in 15 of those, but only 10 patients presented purulent discharge. Due to their hematological status, 5 of the patients require coagulation reversion before surgery.

In the results we detected 3 deaths in the immediate PO (12,5% of the cohort), and a mean of 17 days on hospitalization; with 8 patients returning to theatre due to poor sepsis control. We found according to our experience that haematological patients with perianal sepsis usually present a more complex disease.

CONCLUSIONS:

We conclude that this kind of patient is more fragile having a poor reserve to endure a surgical complication; an oncological status added to an immunosuppression situation determines the need for a lower cutoff for reintervention to avoid a failure to rescue. This is crucial because we should treat perianal sepsis in immunosuppressed patients as a surgical emergency and handle the PO care with this mindset.

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