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Laparoscopic appendectomy in a patient with acute myelogenous leukemia with neutropenia
1Section of Hematology/Oncology, Department of Medicine, Medical College of Georgia, Augusta, Georgia.
Abstract:
The management of acute myelogenous leukemia is often complicated by infections due to neutropenia, but the appendix is not a common site of infection in adult patients with acute myelogenous leukemia. The diagnosis of acute appendicitis may be delayed or even missed because of the lack of characteristic signs and symptoms associated with acute appendicitis in neutropenic patients. Moreover, urgent surgery may lead to high postoperative complications and mortality rates in these patients. The case presented here is of a 33-year-old Hispanic man with acute myelogenous leukemia who developed severe diffuse acute abdominal pain with positive signs of rebound tenderness, fever, and hypotension ten days after receiving reinduction chemotherapy. The patient was at his nadir, with a white blood cell count of 0.2 x 10(9)/L, platelet count of 20 x 10(9)/L, and hemoglobin of 7 g/dL. A computed tomography scan of the abdomen was suspicious for acute appendicitis. The patient underwent a laparoscopic appendectomy that revealed gangrenous appendicitis. No perioperative complications occurred. The patient was discharged on postoperative day 7 and his chemotherapy was continued as scheduled. Laparoscopic appendectomy may be considered a primary approach in neutropenic patients because it can be associated with less postoperative infection, hemorrhagic complications, and a lower mortality rate.
Insights
Acute myelogenous leukemia patients with neutropenia can develop appendicitis, often presenting atypically. Laparoscopic appendectomy offers a safe and effective treatment option with reduced complications in these vulnerable individuals.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Oncology
Background:
- Management of acute myelogenous leukemia (AML) is frequently complicated by infections due to neutropenia.
- Infections of the appendix are uncommon in adult AML patients, and diagnosis of acute appendicitis can be challenging due to atypical presentations in neutropenic individuals.
- Urgent surgery in neutropenic patients carries a high risk of postoperative complications and mortality.
Observation:
- A 33-year-old male with AML presented with severe abdominal pain, fever, and hypotension ten days post-chemotherapy, coinciding with his nadir white blood cell count.
- Computed tomography (CT) scan suggested acute appendicitis.
- The patient underwent a laparoscopic appendectomy, which confirmed gangrenous appendicitis.
Findings:
- The laparoscopic appendectomy was performed without perioperative complications.
- The patient recovered well, was discharged on postoperative day 7, and resumed chemotherapy as planned.
- Histopathology confirmed gangrenous appendicitis.
Implications:
- Laparoscopic appendectomy may be a suitable primary surgical approach for neutropenic patients with suspected appendicitis.
- This minimally invasive technique may lead to decreased postoperative infections, reduced hemorrhagic complications, and lower mortality rates in this high-risk population.
- Early diagnosis and prompt surgical intervention, even with atypical presentations, are crucial for managing appendicitis in neutropenic AML patients.
