A Multidisciplinary Approach to Perianal and Intra-Abdominal Infections in the Neutropenic Cancer Patient

The chemotherapeutic treatment of both hematologic and solid organ malignancies has increased in recent decades, resulting in increased neutropenia-related perianal and intra-abdominal infections. Nearly 30% of neutropenia-related infections arise in the gastrointestinal tract. The management of these patients is often not straightforward, and the indications for and timing of surgical intervention continue to be unclear. The management strategy must take into account such factors as recent chemotherapy toxicity, stage and prognosis of the malignancy, performance status, comorbidities, degree of neutropenia, immunosuppression, thrombocytopenia, and corticosteroid use. The degree and duration of neutropenia is a key determinant of infection resolution. The focus of this review will be the multidisciplinary approach to management of anorectal infection, neutropenic enterocolitis, appendicitis, and cholecystitis in the neutropenic cancer patient.