Appendicitis in a Neutropenic Patient: A Multicentric Retrospective Study

Area of Science:

• Pediatric Oncology
• Pediatric Surgery
• Infectious Diseases

Background:

• Acute appendicitis in neutropenic patients, particularly those undergoing cancer treatment, presents unique management challenges.
• Neutropenia increases the risk of severe complications from infections, necessitating tailored treatment strategies.

Purpose of the Study:

• To evaluate the outcomes of different management strategies for acute appendicitis in pediatric cancer patients.
• To compare nonoperative versus surgical interventions in neutropenic children with appendicitis.

Main Methods:

• Retrospective review of 30 neutropenic children with acute appendicitis treated between 1995 and 2013.
• Analysis of patient demographics, medical records, treatment approaches (nonoperative, early surgery, delayed surgery), and outcomes.
• Comparison of treatment success rates, complications, and hospitalization duration.

Main Results:

• Most patients (90%) had hematological malignancies. Successful nonoperative treatment occurred in 7 patients.
• Early surgery (6 patients) and delayed surgery after antibiotics (17 patients) were successful in all cases, with only 3 experiencing transient complications.
• Appendix perforation was linked to prolonged hospitalization; imaging (ultrasound, CT) was crucial for diagnosis. Surgery was well-tolerated.

Conclusions:

• Early surgical intervention after adequate supportive care is an acceptable and safe management option for acute appendicitis in neutropenic children.
• Prompt surgical management should be considered, especially in life-threatening situations.
• Multidisciplinary care involving pediatric hematology/oncology and surgery is essential for optimal outcomes.