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Keidar HR, Manisterski M, Orenstein M, Sukhotnik I, Elhasid R. Management of acute appendicitis in pediatric patients with acute leukemia: Insights from a single-center study. Pediatr Blood Cancer 2024; 71:e31114. [PMID: 38840423 DOI: 10.1002/pbc.31114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
Acute appendicitis (AA) in pediatric patients with acute leukemia mandates prompt treatment. Diagnosis presents challenges, relying on clinical and radiological assessments, often leading to treatment delays that may disrupt leukemia management. Our study on 14 such cases underscores the pivotal role of swift intervention. While conservative AA treatment may pose no risk to healthy children, our findings mandate the performance of laparoscopic appendectomy within 24 hours of diagnosis. This strategy yielded successful surgical outcomes while ensuring uninterrupted leukemia care. Our experience contributes important insights to the limited understanding of navigating this complex clinical scenario.
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Affiliation(s)
- Hila Rosenfeld Keidar
- Departments of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Manisterski
- Departments of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Orenstein
- Departments of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Sukhotnik
- Departments of Pediatric Surgery, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Elhasid
- Departments of Pediatric Hemato-Oncology, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Colunga-Pedraza JE, Fierro-Saenz S, Lopez-Reyna IG, Colunga-Pedraza PR, Montes-Tapia FF, Antolinez YV, González-Llano O. Escalated doses of methotrexate and L-asparaginase in critically ill children with a concurrent diagnosis of acute lymphoblastic leukemia and appendicitis. Pediatr Blood Cancer 2023; 70:e30140. [PMID: 36519588 DOI: 10.1002/pbc.30140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Affiliation(s)
| | - Samantha Fierro-Saenz
- Department of Hematology, Hospital Universitario "Dr. José Eleuterio González,", Nuevo León, Mexico
| | | | | | | | | | - Oscar González-Llano
- Department of Hematology, Hospital Universitario "Dr. José Eleuterio González,", Nuevo León, Mexico
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Wright Z, Essien F, Renshaw J, Wiggins M, Brown A, Osswald M. Appendiceal disease in hematopoietic cell transplantation. Clin Case Rep 2022; 10:e05047. [PMID: 35140939 PMCID: PMC8813669 DOI: 10.1002/ccr3.5047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022] Open
Abstract
Appendiceal diseases are rare reported complications during hematopoietic stem cell transplantation with no guidance on management in the published literature. Medical therapy may be considered in selected patients prior to surgical solutions.
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Affiliation(s)
- Zachary Wright
- Hematology/Oncology and Bone Marrow Transplant San Antonio Military Medical Center FT Sam Houston Texas USA
| | | | - John Renshaw
- Hematology/Oncology and Bone Marrow Transplant San Antonio Military Medical Center FT Sam Houston Texas USA
| | - Michael Wiggins
- Hematology/Oncology and Bone Marrow Transplant San Antonio Military Medical Center FT Sam Houston Texas USA
| | - Alexander Brown
- Hematology/Oncology and Bone Marrow Transplant San Antonio Military Medical Center FT Sam Houston Texas USA
| | - Michael Osswald
- Hematology/Oncology and Bone Marrow Transplant San Antonio Military Medical Center FT Sam Houston Texas USA
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Park SH, Park SS, Lee DW, Park HC, Park SC, Hong CW, Sohn DK, Han KS, Chang HJ, Oh JH. Comparison between early surgical treatment and conservative treatment of appendicitis in cancer patients. ANZ J Surg 2021; 91:2067-2073. [PMID: 34476891 DOI: 10.1111/ans.17180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUNDS In cancer patients, the optimal appendicitis treatment has not been established. Therefore, we aimed to determine the ideal treatment option for appendicitis in cancer patients. METHODS This retrospective study included 185 cancer patients with acute appendicitis who were divided into the early surgical group (n = 152) involving surgery performed within 48 h following the appendicitis diagnosis or the conservative group (n = 33) involving intravenous antibiotics. We compared the appendicitis treatment efficacy between the groups. RESULTS In the early surgical group, the antibiotic duration [5.5 days (4.0-8.0) vs. 17.0 days (12.5-25.0), p < 0.001] and hospital stay length [7.0 days (5.0-11.75) vs. 10.0 days (8.0-32.0), p < 0.001] were significantly shorter. Regarding pathology, 16/171 (9.4%) patients who underwent surgery exhibited appendiceal tumours. During the 1-year follow-up period, one recurrence occurred in each group [1/152 (0.7%) vs. 1/33 (3.0%), p = 0.326]. The 1-year treatment success rate was higher in the early surgical group [99.3% (151/152) vs. 42.4% (14/33), p < 0.001]. CONCLUSION Early surgical treatment yielded a significantly higher success rate than conservative treatment for appendicitis in cancer patients. Surgery for appendicitis in cancer patients should be considered not only for treatment but also for pathologic confirmation.
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Affiliation(s)
- Sin Hye Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sung Sil Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Dong Woon Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Hyoung-Chul Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Hee Jin Chang
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
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5
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Patel PP, Weller JH, Westermann CR, Cappiello C, Garcia AV, Rhee DS. Appendectomy and Cholecystectomy Outcomes for Pediatric Cancer Patients with Leukopenia: A NSQIP-pediatric Study. J Surg Res 2021; 267:556-562. [PMID: 34261006 DOI: 10.1016/j.jss.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children with cancer often develop leukopenia which may impair wound healing and increase surgical complication rates. When leukopenic children with cancer develop an acute surgical condition, the optimal management strategy remains unclear. This study examined the effect of preoperative leukopenia on postoperative outcomes in children with cancer who underwent an appendectomy or cholecystectomy. METHODS We retrospectively identified cancer patients undergoing an appendectomy or cholecystectomy from the National Surgical Quality Improvement Program-Pediatric database from 2012-2018. Demographics and perioperative characteristics were compared by leukopenia status (WBC <4 vs. ≥4 × 10^3/mL). Postoperative length of stay (LOS) and 30-day composite complications, including infections, reoperations, and readmissions, were analyzed for each procedure using multivariate regression. RESULTS There were 227 children who underwent an appendectomy and 101 children who underwent a cholecystectomy. Leukopenia was seen in 93 (41.0%) appendectomy and 57 (56.4%) cholecystectomy cases. Nineteen (8.4%) appendectomy patients and six (5.9%) cholecystectomy patients developed a postoperative complication. The median postoperative LOS was 2 days (IQR 1-6 days) for appendectomy and 1 day (IQR 1-2.5 days) for cholecystectomy cases. After multivariate analyses, leukopenia was not associated with increased postoperative complications after an appendectomy (OR 0.55, P = 0.36) or cholecystectomy (OR 0.39, P = 0.37). There was no significant difference in postoperative LOS based on leukopenia status for children who underwent an appendectomy (P = 0.82) or cholecystectomy (P = 0.37). CONCLUSION In pediatric cancer patients, leukopenia was not associated with increased short-term postoperative complications or longer postoperative LOS after either an appendectomy or cholecystectomy. These results support that operative management can be performed safely in pediatric appendicitis and cholecystitis in leukopenic cancer patients.
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Affiliation(s)
- Palak P Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennine H Weller
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Carly R Westermann
- Virginia Polytechnic State Institution and University, Blacksburg, Virginia
| | - Clint Cappiello
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland.
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Marison SR, Pati B, Laferriere NR, Woo RK, Ha A. Unexpected diagnosis of acute lymphoblastic leukemia in a 2-year-old with acute appendicitis - Case report. Int J Surg Case Rep 2021; 84:106077. [PMID: 34167071 PMCID: PMC8227831 DOI: 10.1016/j.ijscr.2021.106077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Appendicitis is an extremely common surgical problem, especially in the pediatric population. However, leukemic infiltration of the appendix is rare and even more so is having acute appendicitis as the initial manifestation. CASE PRESENTATION The patient is a 2-year-old female with multiple febrile illnesses since birth, who presented to the emergency department with a 3-day history of abdominal pain, fever, and decreased appetite. Ultrasound of her right lower quadrant was consistent with acute appendicitis. A laparoscopic appendectomy was performed successfully without complication. However, pathological examination of the specimen revealed an appendix with partial involvement of B-lymphoblastic lymphoma/leukemia in a background of lymphoid hyperplasia. This prompted referral to a pediatric hematologist/oncologist. Further workup revealed abnormal immature cells on peripheral blood flow cytometry. Bone marrow biopsy confirmed a diagnosis of B-cell acute lymphoblastic leukemia. CLINICAL DISCUSSION Though acute appendicitis is very common and management is well documented, it is rare for pathological examination to uncover leukemia as an underlying etiology and to have acute appendicitis as the initial manifestation of hematologic malignancy. To our knowledge, very few similar events have occurred and been documented in the medical literature. CONCLUSION Physicians and surgeons should be aware that, though quite rare, leukemic infiltration of the appendix can occur and should be considered in the differential diagnosis of acute appendicitis. Notably, pathologic examination of the appendix may be particularly informative. Diligent follow-up of abnormal pathology is crucial in cases suggestive of underlying hematologic malignancy.
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Affiliation(s)
- Scott R Marison
- The Queens Medical Center, Department of Surgery, 1356 Lusitana Street, 6th Floor, Honolulu, HI 96813, United States of America.
| | - Brooke Pati
- Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, United States of America
| | - Nicole R Laferriere
- Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, United States of America
| | - Russell K Woo
- Kapiolani Medical Center for Women and Children, Department of Pediatric Surgery, 1319 Punahou St, Honolulu, HI 96826, United States of America
| | - Ally Ha
- Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, United States of America
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Kojima K, Nakamura T, Habiro T, Waraya M, Hayashi K, Ishii KI. Laparoscopic Appendectomy for Acute Appendicitis Complicated by Pancytopenia in Two Patients with Hematologic Diseases. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:188-191. [PMID: 33937560 PMCID: PMC8084534 DOI: 10.23922/jarc.2020-077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
A 25-year-old male (Case 1) was waiting for a bone marrow transplant for myelodysplastic syndrome. Due to acute appendicitis, he was advised to undergo gastroenterological surgery. After blood transfusion, he underwent an emergency laparoscopic appendectomy, as no blood cell recovery was expected. The postoperative course was uneventful, and he was discharged. A 71-year-old female (Case 2) developed acute appendicitis during chemotherapy for acute myeloid leukemia (AML). At the time of onset, since her myelosuppression was expected to improve in approximately 1 week, a conservative treatment was administered. However, due to the progression of AML, the expected blood cell recovery did not occur. Therefore, laparoscopic appendectomy was performed 25 days after onset. She was discharged without postoperative adverse events. In cases of acute appendicitis in patients with hematologic disease accompanied by pancytopenia, it is important to establish a careful treatment plan considering the possibility of recovery from myelosuppression and the need to control an intraperitoneal infection in conjunction with a hematologist. Laparoscopic surgery, which is minimally invasive, was an effective surgical procedure.
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Affiliation(s)
- Keita Kojima
- Department of Surgery, Japan Community Health care Organization Sagamino Hospital, Sagamihara, Japan
| | - Takatoshi Nakamura
- Department of Surgery, Japan Community Health care Organization Sagamino Hospital, Sagamihara, Japan.,First Department of Surgery, Dokkyo Medical University, Shimotsuga, Japan
| | - Takeyoshi Habiro
- Department of Surgery, Japan Community Health care Organization Sagamino Hospital, Sagamihara, Japan
| | - Mina Waraya
- Department of Surgery, Japan Community Health care Organization Sagamino Hospital, Sagamihara, Japan
| | - Keiko Hayashi
- Department of Surgery, Japan Community Health care Organization Sagamino Hospital, Sagamihara, Japan
| | - Ken-Ichiro Ishii
- Department of Surgery, Japan Community Health care Organization Sagamino Hospital, Sagamihara, Japan
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8
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Appendicitis in Neutropenic Pediatric Oncology Patients: A Case Series and Review of the Literature. J Pediatr Hematol Oncol 2020; 42:e835-e838. [PMID: 32079990 DOI: 10.1097/mph.0000000000001762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Appendicitis is the most common reason for which pediatric patients require emergent surgery. Although surgical removal of the appendix is the standard of care for appendicitis, neutropenic patients require special consideration as optimal management for these patients remains controversial. We present a case series of 3 neutropenic patients with appendicitis, all of whom were managed differently according to the circumstances unique to each case. By reviewing key articles in the literature, we explore the safety and efficacy of both medical and surgical management of neutropenic appendicitis and propose an algorithm to help guide decision making.
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Claffey AJ, Lal DR, Lautz TB, Rokitka DA, Rothstein DH. Appendectomy in pediatric patients with synchronous oncologic diagnosis is safe: an analysis using the national surgical quality improvement project, pediatric. Pediatr Surg Int 2020; 36:1333-1338. [PMID: 32915275 DOI: 10.1007/s00383-020-04743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Optimal treatment of children who develop appendicitis while undergoing treatment for an oncologic diagnosis has not been defined, in part due to theoretical concerns for an increased risk of postoperative wound complications. We hypothesized that synchronous oncologic diagnosis conferred no increased odds of developing a wound complication in pediatric patients undergoing appendectomy. METHODS Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric (2012-2017) of patients < 18 years of age undergoing appendectomy. The main exposure variable was active treatment for an oncologic diagnosis. The primary outcomes of interest were 30-day wound complications (superficial or deep infections or dehiscence, and abscess). For univariate analysis comparison of baseline differences between patients with/without a cancer diagnosis we employed Pearson's χ2 and two sample t tests. Multivariate logistic regression was used to evaluate which covariates were independently associated with our outcome. RESULTS We identified 28,219 patients who had undergone appendectomy; 95 (0.3%) were undergoing oncologic treatment at the time of surgery. Patients in the cancer group were more likely to be receiving steroids, have lower white blood cell counts and have higher American Society of Anesthesiology classes as compared to the noncancer patients. Age, gender, rates of perforation, and laparoscopy were similar between the two groups. Patients with an active cancer diagnosis suffered wound complications (measured individually and as an aggregate) at no higher odds than those without a cancer diagnosis. CONCLUSION Pediatric patients undergoing treatment for cancer do not have increased odds of suffering postoperative wound complications following appendectomy as compared to the general population.
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Affiliation(s)
- Andrew J Claffey
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, 14214, USA
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA
| | - Timothy B Lautz
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Denise A Rokitka
- Department of Pediatrics and Division of Hematology and Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - David H Rothstein
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, 14214, USA. .,Department of Pediatric Surgery, John R. Oishei Children's Hospital, 1001 Main St, Buffalo, NY, 14203, USA.
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Ali A, Alhindi S, Alalwan AA. Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review. Cureus 2020; 12:e8858. [PMID: 32617245 PMCID: PMC7325351 DOI: 10.7759/cureus.8858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute appendicitis is a rare but important complication in children with leukemia. It can be difficult to diagnose, and it has a complicated disease course, especially in patients receiving chemotherapy. Awareness of these complications is critical, particularly in cases where surgical intervention is required. We report a child with T-cell acute lymphoblastic leukemia and chemotherapy-induced neutropenia who presented with acute appendicitis. He was successfully treated with broad-spectrum empiric antibiotics and a delayed laparoscopic appendectomy.
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Affiliation(s)
- Alaa Ali
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
| | - Saeed Alhindi
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
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Coccolini F, Fugazzola P, Sartelli M, Cicuttin E, Sibilla MG, Leandro G, De' Angelis GL, Gaiani F, Di Mario F, Tomasoni M, Catena F, Ansaloni L. Conservative treatment of acute appendicitis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:119-134. [PMID: 30561405 PMCID: PMC6502196 DOI: 10.23750/abm.v89i9-s.7905] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Acute appendicitis has been considered by surgeons a progressive disease leading to perforation for more than 100 years. In the last decades the theories about this concept gained attention, especially in adults. However, appendectomy for acute appendicitis remains the most common urgent/emergent surgical procedure. At present, accumulating evidences are showing the changing in clinical practice towards the non-operative management of several cases of acute appendicitis either non-complicated or complicated. The present review aims to show the literature results regarding the non-operative management of acute appendicitis in non-complicated and in complicated cases.
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Affiliation(s)
- Federico Coccolini
- Emergency, General and Trauma Surgery dept., Bufalini hospital, Cesena, Italy.
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Abstract
To study the management of acute appendicitis in neutropenic patients, we retrospectively reviewed cases of acute appendicitis in neutropenic children treated for cancer. The patients' demographics, medical records, and outcomes were tracked. We compared nonoperative treatment versus emergency or delayed surgery. The cases of 30 patients with a mean age of 8.8 years in 12 French departments of Pediatric Hematology/Oncology between 1995 and 2013 were studied. Most patients (90%) were treated for hematological malignancies. Seven of the 30 children were successfully treated with exclusive medical treatment. Early surgery was performed in 6 patients, and the remaining 17 underwent combined management with a first-line antibiotic treatment and delayed appendectomy. Treatments were successful in all cases with transitory complications in only 3 patients. No death linked to infection was reported. Surgery was well tolerated even in the neutropenic period. Appendix perforation was a major risk factor of prolonged hospitalization. Histologic as well as bacteriologic and mycologic/parasitologic analyses were required in case of surgery. Analysis of diagnostic assessments showed the major importance of imaging (ultrasonography and tomography) on diagnosis confirmation. We could not come to a conclusion in the few numbers of reviewed cases because of a significant difference in management strategies, but we can conclude that early surgery after adequate supportive care is an acceptable modality of treatment and must be chosen in the face of life-threatening conditions.
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Fungal Appendicitis in Immunocompromised Children. Indications and Contraindications for Laparoscopic Appendectomy: A Report on 2 Successful Cases. J Pediatr Hematol Oncol 2016; 38:581-4. [PMID: 27164525 DOI: 10.1097/mph.0000000000000563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In leukemic patients, appendectomy must be approached with caution because of the increased risk of complications. Fungal appendicitis is rare and only a few cases have been described in the literature, particularly in immunocompromised individuals in whom this infection can be fatal. We present 2 pediatric patients with acute myeloid leukemia, who developed appendicitis during the postchemotherapy neutropenic phase, while receiving antifungal prophylaxis. Fever was the first sign of infection. Laparoscopic appendectomy was performed without postoperative complications. The histologic examination and the culture analysis showed the presence of fungal elements; systemic fungal infection was also excluded. The risk is increased in immunocompromised children with fungal appendicitis and the signs of peritoneal irritation are not always obvious. The histopathologic demonstration of fungal elements and tissue reaction is mandatory for a definitive diagnosis. Laparoscopic appendectomy should be considered as the gold standard procedure to avoid fungal dissemination. Moreover, laparoscopic surgery and its inherent mini-invasive surgical advantages may improve the overall survival without incurring significant complications.
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14
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Castagnola E, Ruberto E, Guarino A. Gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy in the years 2000. World J Gastroenterol 2016; 22:5853-5866. [PMID: 27433098 PMCID: PMC4932220 DOI: 10.3748/wjg.v22.i25.5853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/27/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To review gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy. To look at gut microflora features in oncology children.
METHODS: We selected studies published after year 2000, excluding trials on transplanted pediatric patients. We searched English language publications in MEDLINE using the keywords: “gastrointestinal infection AND antineoplastic chemotherapy AND children”, “gastrointestinal infection AND oncology AND children”, “liver infection AND antineoplastic chemotherapy AND children”, “liver abscess AND chemotherapy AND child”, “neutropenic enterocolitis AND chemotherapy AND children”, “thyphlitis AND chemotherapy AND children”, “infectious diarrhea AND children AND oncology”, “abdominal pain AND infection AND children AND oncology”, “perianal sepsis AND children AND oncology”, “colonic pseudo-obstruction AND oncology AND child AND chemotherapy”, “microflora AND children AND malignancy”, “microbiota AND children AND malignancy”, “fungal flora AND children AND malignancy”. We also analysed evidence from several articles and book references.
RESULTS: Gastrointestinal and liver infections represent a major cause of morbidity and mortality in children undergoing antineoplastic chemotherapy. Antineoplastic drugs cause immunosuppression in addition to direct toxicity, predisposing to infections, although the specific risk is variable according to disease and host features. Common pathogens potentially induce severe diseases whereas opportunistic microorganisms may attack vulnerable hosts. Clinical manifestations can be subtle and not specific. In addition, several conditions are rare and diagnostic process and treatments are not standardized. Diagnosis may be challenging, however early diagnosis is needed for quick and appropriate interventions. Interestingly, the source of infection in those children can be exogenous or endogenous. Indeed, mucosal damage may allow the penetrance of endogenous microbes towards the bowel wall and their translocation into the bloodstream. However, only limited knowledge of intestinal dysbiosis in oncology children is available.
CONCLUSION: The diagnostic work-up requires a multimodal approach and should be implemented (also by further studies on new biomarkers) for a prompt and individualized therapy.
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Singer J, Stringel G, Ozkaynak MF, McBride W, Pandya S, Sandoval C. Laparoscopic Surgery for Acute Appendicitis in Children With Cancer. JSLS 2016; 19. [PMID: 26390529 PMCID: PMC4558416 DOI: 10.4293/jsls.2015.00066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Abdominal pain during cancer chemotherapy may be caused by medical or surgical conditions. A retrospective review of 5 children with cancer who had appendicitis while receiving chemotherapy was performed. CASE DESCRIPTIONS Three had acute lymphoblastic leukemia,and 1 each had T-cell lymphoblastic lymphoma and rhabdomyosarcoma. Two of the patients had a Pediatric Appendectomy Score of 6, and 1 each had a score of 7, 5, and 2. All had evidence of appendicitis on computed tomography. Laparoscopic appendectomy was performed without any perioperative complication. DISCUSSION Appendicitis is an important diagnosis in children with cancer, and laparoscopic appendectomy is safe and the procedure of choice.
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Sullivan PS, Moreno C, Shaib WL. Management of anorectal and intra-abdominal infections in the neutropenic cancer patient. Curr Probl Cancer 2015; 39:274-86. [PMID: 26566580 DOI: 10.1016/j.currproblcancer.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wong CWY, Chung PHY, Lan LCL, Wong KKY. Acute appendicitis presenting as pneumoperitoneum in a teenage boy undergoing chemotherapy. BMJ Case Rep 2015; 2015:bcr-2015-210347. [PMID: 26443090 DOI: 10.1136/bcr-2015-210347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chemotherapy of paediatric haematological malignancies can induce infectious complications of the gastrointestinal tract, with predilection of the ileocaecal region. Common causes of right lower abdominal pain in the febrile patient with neutropaenia include acute appendicitis, typhlitis, ileus and intussusception. In this case report, we describe a teenage boy with acute appendicitis presenting with pneumoperitoneum during his course of chemotherapy. The incidence, aetiology, diagnosis, investigations and management of this uncommon presentation in a common disease are discussed. The controversial topic of the management of acute appendicitis in a febrile patient with neutropaenia is also reviewed and discussed.
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Affiliation(s)
- C W Y Wong
- Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - P H Y Chung
- Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - L C L Lan
- Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - K K Y Wong
- Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
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Steiner Z, Buklan G, Stackievicz R, Gutermacher M, Erez I. A role for conservative antibiotic treatment in early appendicitis in children. J Pediatr Surg 2015; 50:1566-8. [PMID: 26341885 DOI: 10.1016/j.jpedsurg.2015.04.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/10/2015] [Accepted: 04/20/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate whether antibiotics without surgery is sufficient treatment for children with clinically and ultrasonographically suspected acute appendicitis (AA). METHOD Children with clinical, laboratory and radiological findings suspicious for AA were evaluated prospectively. Patients with mild clinical signs, without peritonitis were considered for IV followed by oral antibiotics without surgery. RESULTS From 1 November 2013 through 30 June 2014, 45 children were diagnosed with early, acute appendicitis. Ages ranged from 4 to 15 years (mean 9.3) and 32 (75%) were boys. All had routine, clinical laboratory and ultrasound workup. Forty-two improved with antibiotic treatment and were discharged home within 3-5 days, without surgery. Three of them were operated on within 24 hours, another two underwent appendectomy for recurrent appendicitis: one at 2 weeks and the other 2 months after discharge. There was no more recurrent appendicitis in 6-14-month follow-up. CONCLUSION Our series of patients with AA treated with antibiotics only are a product of the observation that some children improve with antibiotics alone at a stage in which surgery is still debatable. These results (89% success rate) support the conservative approach in cases of early appendicitis, without increased morbidity in failed cases.
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Affiliation(s)
- Zvi Steiner
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Genady Buklan
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Rodica Stackievicz
- Tel Aviv University, Tel Aviv, Israel; Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Michael Gutermacher
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ilan Erez
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel
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Acute appendicitis in acute leukemia and the potential role of decitabine in the critically ill patient. Leuk Res Rep 2015; 4:21-3. [PMID: 25870788 PMCID: PMC4392291 DOI: 10.1016/j.lrr.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/29/2015] [Accepted: 03/03/2015] [Indexed: 11/21/2022] Open
Abstract
Acute appendicitis in children with acute leukemia is uncommon and often recognized late. Immunocompromised host state coupled with the importance of avoiding treatment delays makes management additionally challenging. Leukemic infiltration of the appendix though rare must also be considered. Although successful conservative management has been reported, surgical intervention is required in most cases. We present our experience with acute appendicitis in children with acute leukemia and a case of complete remission of acute myeloid leukemia with a short course of decitabine. Decitabine may serve as bridging therapy in critically ill patients who are unable to undergo intensive chemotherapy.
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Meralgia Paresthetica as a Presentation of Acute Appendicitis in a Girl With Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2015; 37:e182-3. [PMID: 24942034 DOI: 10.1097/mph.0000000000000189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 7-year-old girl with Philadelphia chromosome-positive acute lymphoblastic leukemia developed recurrent fever and meralgia paresthetica (MP) during chemotherapy, which resolved after administration of antibiotics. Five months after the onset of these symptoms, enhanced computed tomography showed a periappendiceal abscess extending into the psoas muscle. The cause of her fever and MP was thought to be appendicitis, which probably developed during induction chemotherapy but did not result in typical abdominal pain. Patients with recurrent fever and MP should be evaluated by imaging examinations including computed tomography to search for appendicitis.
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Gorter RR, van der Lee JH, Cense HA, Kneepkens CMF, Wijnen MHWA, In 't Hof KH, Offringa M, Heij HA. Initial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a multicenter, prospective cohort study. Surgery 2015; 157:916-23. [PMID: 25791031 DOI: 10.1016/j.surg.2015.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/30/2014] [Accepted: 01/11/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Initial antibiotic treatment for acute appendicitis has been shown to be safe in adults; so far, not much is known about the safety and efficacy of this treatment in children. The aims of this study were to investigate the feasibility of a randomized controlled trial (RCT) evaluating initial antibiotic treatment for acute appendectomy in children with acute simple appendicitis and to evaluate the safety of this approach. METHODS In a multicenter, prospective cohort study patients aged 7-17 years with a radiologically confirmed simple appendicitis were eligible. Intravenous antibiotics (amoxicillin/clavulanic acid 250/25 mg/kg 4 times daily; maximum 6,000/600 mg/d and gentamicin 7 mg/kg once daily) were administered for 48-72 hours. Clinical reevaluation every 6 hours, daily blood samples, and ultrasound follow-up after 48 hours was performed. In case of improvement after 48 hours, oral antibiotics were given for a total of 7 days. At any time, in case of clinical deterioration or non-improvement after 72 hours, an appendectomy could be performed. Follow-up continued until 8 weeks after discharge. Adverse events were defined as major complications of antibiotic treatment, such as allergic reactions, perforated appendicitis, and recurrent appendicitis. RESULTS Of 44 eligible patients, 25 participated (inclusion rate, 57%; 95% CI, 42%-70%). Delayed appendectomy was performed in 2, and the other 23 were without symptoms at the 8 weeks follow-up. Minor complications occurred in three patients. None of the patients suffered from an adverse event or a recurrent appendicitis. CONCLUSION Our study shows that an RCT comparing initial antibiotic treatment strategy with urgent appendectomy is feasible in children; the intervention seems to be safe.
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Affiliation(s)
- Ramon R Gorter
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
| | - Johanna H van der Lee
- Paediatric Clinical Research Office Division Woman and Child, Academic Medical Centre, Amsterdam, The Netherlands
| | - Huibert A Cense
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - C M Frank Kneepkens
- Department of Paediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marc H W A Wijnen
- Department of Paediatric Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Martin Offringa
- Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Hugo A Heij
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands
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Appendizitis. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-012-2758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Nonsurgical treatment with antibiotics has recently been proposed as the first line of treatment for noncomplicated appendicitis. This has met with considerable interest, illustrated by the number of reviews and meta-analyses, which exceed the number of original reports of the issue. The results in these studies are seriously biased due to inclusion of patients with resolving appendicitis. At a time when we need to reduce inappropriate use of antibiotics in the struggle against the increasing rate of antibiotics resistance, there must be strong requirements of a proven effect and an improved cost-benefit ratio before antibiotics treatment is introduced for a new group of patients. These requirements have not yet been met for nonsurgical treatment with antibiotics for assumed uncomplicated appendicitis. Due to the high rate of spontaneous resolution, a randomized placebo-controlled trial is needed that can compare the efficiency of antibiotics treatment and expectant management in this group of patients. Antibiotics treatment, however, remains indicated for treatment of perforated appendicitis with localized abscess or phlegmone and in selected surgical high-risk patients.
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Affiliation(s)
- Roland E Andersson
- Department of Surgery, County Hospital Ryhov, 551 85, Jönköping, Sweden,
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Appendectomy in Neutropenic Children: A Safe and Expedient Solution to a Challenging Problem. J Surg Res 2012; 178:110-2. [PMID: 21777928 DOI: 10.1016/j.jss.2011.05.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 05/23/2011] [Accepted: 05/23/2012] [Indexed: 11/22/2022]
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Kim EY, Lee JW, Chung NG, Cho B, Kim HK, Chung JH. Acute appendicitis in children with acute leukemia: experiences of a single institution in Korea. Yonsei Med J 2012; 53:781-7. [PMID: 22665346 PMCID: PMC3381485 DOI: 10.3349/ymj.2012.53.4.781] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Acute appendicitis has been reported to be relatively rare in pediatric leukemia patients but there is no official data for this in Korea. And there is no consensus for its treatment in this population. MATERIALS AND METHODS We conducted a retrospective study of 7 patients diagnosed with appendicitis among 1209 pediatric patients who were diagnosed with leukemia from 1996 to 2008 at a single institution in Korea. RESULTS The median age at the time of the diagnosis of appendicitis was 12 years (range: 3-15 years), and 3 of the patients were male. The median absolute neutrophil count (ANC) at the time of diagnosis was 0.99×10⁹/L (range: 0-3×10⁹/L). The mean time from the onset of symptoms to the diagnosis was 4 days. All 7 leukemia patients with appendicitis underwent surgery and they demonstrated a survival of 100% without significant complications. CONCLUSION The incidence of appendicitis in pediatric leukemia patients was 0.57% in our study. Early diagnosis with abdominal ultrasound or computed tomography and early surgical resection in leukemic patient with acute appendicitis may be a safer and more effective treatment option. Even when perforation has already occurred and when the patient has an ANC of 0×10⁹/L, surgical treatment may improve overall survival without incurring significant complications.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nak-Gyun Chung
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hack-Ki Kim
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hee Chung
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
AIM To describe the symptoms, clinical management and short-term outcome in a series of paediatric oncology patients with severe typhlitis following conservative treatment. METHODS Twelve episodes of severe typhlitis in 11 children with cancer treated at the paediatric oncology ward at Queen Silvias Children's Hospital between 1995 and 2006 were analysed retrospectively. Data on symptoms, radiological findings, laboratory status and treatment as well as outcome were collected and analysed. RESULTS In all episodes, the classical signs of neutropenia, fever, abdominal pain and thickening of the bowel wall were present. All were successfully treated with bowel rest, broadspectrum antibiotics and supportive care. After recovery from typhlitis, three patients needed surgical intervention because of complications. CONCLUSION A high clinical suspicion combined with radiological imaging aids early diagnosis. Predisposing factors for developing typhlitis were haematologic malignancy and treatment with chemotherapy within 3 weeks of onset. Supportive care, bowel rest including parenteral nutrition, correction of cytopenias and aggressive antimicrobial treatment is essential. Measurements of C-reactive protein in blood may be of benefit when assessing the clinical course.
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Affiliation(s)
- Nicklas Sundell
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Mortellaro VE, Juang D, Fike FB, Saites CG, Potter DD, Iqbal CW, Snyder CL, St. Peter SD. Treatment of Appendicitis in Neutropenic Children. J Surg Res 2011; 170:14-6. [PMID: 21514602 DOI: 10.1016/j.jss.2011.03.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/07/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
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