# Anorectal Complications in Acute Leukaemia: A retrospective analysis of clinical characteristics, management and outcomes in a tertiary care setting in Oman

## TL;DR

This study examines anorectal complications in acute leukemia patients in Oman, finding fissures as the most common issue and highlighting the need for early detection.

## Contribution

The study provides new insights into the clinical characteristics and management of anorectal complications in acute leukemia patients in a specific regional context.

## Key findings

- Fissures were the most common anorectal complication among acute leukemia patients.
- Abscesses required collaborative management between Surgery and Infectious Diseases teams.
- AML patients had a higher recurrence rate of anorectal complications.

## Abstract

Anorectal complications are common and serious issues among patients with haematological malignancies, leading to significant morbidity and mortality. Limited data are available on their incidence, microbiology screening and management. This study aimed to improve the understanding of these complications in patients diagnosed with acute leukaemia in Oman.

This retrospective study was conducted at Sultan Qaboos University Hospital, Muscat, Oman and included patients diagnosed with acute leukaemia who developed anorectal complications over the past decade (2015–2024).

A total of 100 patients were included in this study; 50% had acute myeloid leukaemia (AML), 35% had acute lymphoblastic leukaemia (ALL) and 36% were newly diagnosed. Of the 119 anorectal complications, fissures were the most common (n = 48/119). Only 19 patients had culture-proven anorectal infections, most commonly caused by Pseudomonas. Both the Surgery and Infectious Diseases teams were involved in management, especially for abscesses. The majority of patients were treated with meropenem (n = 44/176) and metronidazole (n = 39/176). The recurrence rate was 40% and found to be higher among AML patients. A total of 16% of the patients died within 30 days of diagnosing anorectal complications. But their mortality was indirectly related to the anorectal complications.

Anorectal complications were prevalent among these patients, particularly in those with AML and were more common among newly diagnosed individuals. Fissures were the most frequently observed complication, while abscesses posed the most significant management challenge, requiring collaboration between Surgery and Infectious Diseases teams. Close monitoring of patients can facilitate early detection and intervention of these complications.