[Anorectal lesions in hemopathies]. / Les lésions anorectales au cours des hémopathies.

An understanding of anorectal lesions during hemopathy is of value since this disorder can be difficult to identify and treat. The authors report three cases of anorectal lesions during hemopathy. The following points emerged from this study, and from literature data: hemopathic disorders should be born in mind in cases of acute anal syndromes; the relative frequency of acute leukemia of specific lesions: nodules, in patches or aspecific: purpura, hematoma, fissures, ulceration, ulcers; marked neutropenia in leukemia and agranulocytosis; severity of anal surgery, which should be prudent. Atypical anal lesions may indicate hemopathy. They may respond favorably to medical treatment; prognostic severity of these lesions, especially if ulcerous and necrotic.

[Pseudomembranous rectocolitis]. / Les rectocolites pseudo-membraneuses.

The following conclusions were drawn from a study of 15 cases of pseudo-membranous coloproctitis (PMCP): PMCP was seen in subjects of both sexes and all ages. The causative agent was found in all antibiotic classes. Clinical signs comprised constant diarrhea, fever, abdominal pain, toxic shock and, more rarely, pseudo-occlusive, pseudo-perforative surgical evidence. Diagnosis involved visualization of pseudo-membranes by endoscopy. Lesions were most frequent in the left colon and increased in severity towards the distal end. Three stages were distinguished by histological examination: superficial necrosis of the mucous membranes, interruption of glands, complete necrosis of the mucous membrane. Without preparation the abdomen did not provide specific information; nor did barium enema which revealed lesions that were frequently diffuse but more marked in the left colon. Conventional coprocultures did not provide diagnostic information. Only a more sophisticated technique will be capable of detecting the pathogen currently considered to be the cause of PMCP: Clostridium difficile. The course of the disorder is generally satisfactory under medical treatment (parenteral feeding, vancomycin) but may sometimes call for surgery.