Twenty-two patients who, in the course of acute or chronic leukemia, developed perianal and anorectal complications are described. These lesions were indurated firm areas about the anal opening; fluctuant ischiorectal abscesses; fistulas with abscesses and induration around them; fissures with edematous sentinel piles and abscesses around them, and thrombosed ulcerated hemorrhoids. T h e combination of symptomatic and radiation therapy is the most effective means of controlling perianal complications in uncontrolled acute a n d chronic leukemia. T h e procedures and regimens using combined symptomatic a n d radiation therapy are defined. T h e timing of appropriate surgical intervention is discussed. T h e hazards of the injudicious use of any one of these modalities are described.
HE MANAGEMENT OF PERIANAL AND ANO-
T rectal abscesses, fistulas, and fissures are extensively described and discussed in the literature. These complications occurring in patients suffering from leukemias are not discussed widely. Wide incision and drainage are recognized ways of treating perianal abscesses, but injudicious use of this procedure in patients with acute leukemia or uncontrolled chronic leukemias can result in necrosis of the whole perianal area accompanied by uncontrolled septicemia and hemorrhage. It is our purpose here to delineate the indications for radiation therapy, surgical and or symptomatic management for such complications in patients with leukemia.
I n 1934, Walsh and Stickley6 described a patient whose leukemia was discovered after he presented with an anorectal abscess. In 1955, Blank1 described five cases of leukemia in whom anorectal complications developed. Symptomatic treatment was successful in one patient. Two patients died of massive sloughs of perianal and anorectal tissues. Two pa-