A 42- year old man is undergoing chemotherapy after resection of a cecal adenocarcinoma with positive lymph nodes. You are asked to see him regarding a potential surgical complication. Which of the following potentially operable complications is a common occurrence among patients receiving systemic chemotherapy?
a. The immunocompromised patient with perianal pain presents a diagnostic dilemma.
b. Because of leukopenia, these patients may develop serious perianal infection without any of the cardinal signs of inflammation.
c. While broad-spectrum antibiotics may cure some of these patients, an exam under anesthesia should not be delayed because of neutropenia.
d. An increase in pain or fever, and/or clinical deterioration mandates an exam under anesthesia.
e. Any indurated area should be incised and drained, biopsied to exclude a leukemic infiltrate, and cultured to aid in the selection of antimicrobial agents.
f. Necrotizing soft-tissue infection of the perineum is a rare, but lethal, condition. Most of these infections are polymicrobial and synergistic.
g. The source of sepsis is commonly an undrained or inadequately drained cryptoglandular abscess or a urogenital infection.
h. Occasionally, these infections may be encountered postoperatively (e.g., after inguinal hernia repair).
j. Physical examination may reveal necrotic skin, bullae, or crepitus. Patients often have signs of systemic toxicity and may be hemodynamically unstable.
k. Surgical débridement of all nonviable tissue is required to treat all necrotizing soft-tissue infections.
l. Multiple operations may be necessary to ensure that all necrotic tissue has been resected.