Treatment of appendicitis in neutropenic children

Appendicitis in the neutropenic patient places the clinician in a precarious position; balancing the timing and risks of surgery and the risk of an uncontrolled infectious source in the abdomen.

Multi-center retrospective review from 2000 to 2010 of appendicitis occurring in patients with neutropenia secondary to chemotherapy. Patient demographics and surgical outcomes were tracked.

There were 11 patients, mean age of 11 y (3-17 y); six were male. Mean weight was 46.9 kg (18.1-72.6 kg). Mean body mass index was 20.9 kg/m(2) (16.8-27.3 kg/m(2)). There were five acute lymphocytic leukemias, four acute myeloblastic leukemias, one T-Cell lymphoma, and one Ewing's sarcoma. Mean presenting white blood cell count was 1900 (0.2-4.4). Average absolute neutrophil count was 900 (0.00-2.6). Computed tomography scan was used in all patients. Appendectomy was performed within 24 h of presentation in all patients, three were perforated. Mean time to first feeding was 1 d (range, 0-5 d), goal feeds at 3 d (range, 1-6 d ). Mean length of stay from appendicitis was 4 d.

Early appendectomy for appendicitis in neutropenic patients appears to be tolerated well with a low risk of surgical complications.