Severe Necrotizing Perianal Cellulitis in a Child with Acute Lymphoblastic Leukemia that Developed After Rectal Enema Use

Öz

Rectal applications are not recommended in patients who receive chemotherapy for malignant hematological diseases as they can cause serious complications, especially during neutropenic periods. Minimal mucosal damage during a rectal application can lead to cellulitis, abscess formation and fi stulization. Our case is a 7-year-old boy who had been newly diagnosed with acute lymphoblastic leukemia. While he was undergoing induction therapy, rectal enema was administered at home because of two days of constipation after discharge from the hospital. The patient developed severe necrotizing perianal cellulitis and needed wide debridement, colostomy opening and autologous skin engraftment for treatment. We decided to present our case to once again emphasize the importance of this topic

Anahtar Kelimeler

• Child, Leukemia, Neutropenia, Cellulitis

Akut Lenfoblastik Lösemili Çocukta Nötropenik Dönemde Rektal Lavman Uygulaması Sonucu Gelişen Ağır Nekrotizan Perianal Selülit

Öz

Hematolojik malignite nedeniyle kemoterapi alan hastalarda, özellikle nötropenik olduğu dönemlerde rektal uygulamalar ciddi komplikasyonlara yol açabileceği için önerilmemektedir. Uygulama sırasında anüs veya rektum mukozasında oluşabilecek minimal hasar hızlı bir şekilde selülit, abse veya fistül gelişimine zemin hazırlayabilmektedir. Olgumuz 7 yaşında erkek hasta olup yeni akut lenfoblastik lösemi tanısı konulmuştur. İndüksiyon tedavisi sırasında taburcu edilen hastaya iki gündür olan kabızlık nedeniyle evde rektal lavman uygulanması sonrasında tedavisinde geniş cerrahi debridman, kolostomi açılması ve otolog deri grafti uygulanması gerektirecek ağır nekrotizan perianal selülit gelişti. Olgu konunun önemini bir kez daha vurgulamak için sunulmuştur.

Anahtar Kelimeler

• Çocuk, Lösemi, Nötropeni, Selülit

Kaynakça

1. Rheingold S. Management of oncologic emergencies. In: Lanzkowsky P (ed). Manual of Pediatric Hematology and Oncology. 5th ed. San Diego: Elsevier, 2011:839-56.
2. Walsh TJ, Roilides E, Groll AH, Gonzales C, Pizzo PA. Infectious complications in pediatric cancer patients. In: Pizzo PA, Poplack DG (eds). Principles and Practice of Pediatric Oncology, 5th ed. Philadelphia: JP Lippincott, 2006:1269-329.
3. Freifeld A, Bow E, Sepkowitz K, Boeckh M, Ito J, Mullen C, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infec Dis 2011;52:56-93
4. Altınel E, Yaralı N, Işık P, Özkasap S, Bay A, Kara A ve ark. Evaluation of febrile neutropenia in children with acute leukemia. Turkish J Pediatr Dis 2012;6:93-100.
5. Yılmaz S, Oren H, Demircioğlu F, Irken G. Assessment of febrile neutropenia episodes in children with acute leukemia treated with BFM protocols. Pediatr Hematol Oncol 2008;25:195-204.
6. Jones GR, Konslet GK, Pusek SN. Infection risk factors in febrile, neutropenic children and adolescents. Pediatr Hematol Oncol 1996;13:217-29.
7. Bonilla MA. Disorders of white blood cells. In: Lanzkowsky P (ed). Manual of Pediatric Hematology and Oncology. 5th ed. San Diego: Elsevier, 2011:272-320.
8. Rolston KV, Bodey GD. Diagnosis and management of perianal and perirectal infection in the granulocytopenic patients. In: Remington J, Swartz MN (eds). Current Clinical Topics in Infectious Diseases. Boston: Blackwell, 1993;164-71.

9. Carlson GW, Ferguson CM, Amerson JR. Perianal infections in acute leukemia. Am J Surg 1988;54:693-5.
10. Güneş D, Mutafoğlu K, Çetinkaya H, Arslan H, Çakır D, Olgun N. Febrile neutropenic episodes in children with lymphoma and malignant solid tumors. J Pediatr Inf 2010;4:1-8.
11. Brook J, Frazier EH. The aerobic and anaerobic bacteriology of perirectal abscesses. J Clin Microbiol 1997;35:2974-6.
12. Cohen JS, Paz IB, O’Donnell MR, Ellenhom JD. Treatment of perianal infections following bone marrow transplantation. Dis Colon Rectum 1996;39: 981-5.
13. Grewal H, Guillem J, Quan SHQ, Enker WE, Cohen A. Anorectal disease in neutropenic leukemic patients. Dis Colon Rectum 1994;37:1095-9.
14. Angel C, Patrick C, Lobe T, Rao B, Pui C. Management of anorectal/ perianal infections caused by Pseudomonas aeruginosa in children with malignant diseases. J Pediatr Surgery 1991;26:487-93.
15. Glenn J, Cotton D, Wesley R, Pizzo P. Anorectal infection in patients with malignant diseases. Clin Infec Dis 1998;10:42-52.