Acute Appendicitis in Pediatric Hematopoietic Stem Cell Transplant Recipients: A Single-Center Experience

To evaluate the clinical features and outcomes of early laparoscopic appendectomy in pediatric patients who developed acute appendicitis following hematopoietic stem cell transplantation (HSCT).

This retrospective, single-center study included 10 pediatric patients diagnosed with acute appendicitis after undergoing allogeneic HSCT between 2015 and 2025. Demographics, laboratory values, imaging findings, surgical timing, and outcomes were recorded.

Among 737 pediatric HSCT recipients, 10 patients (1.4%) developed acute appendicitis. The median age was 13 years (range: 4-16), and 80% were male. Nine patients had a diagnosis of acute lymphoblastic leukemia and one had aplastic anemia. Appendicitis was diagnosed at a median of 23.5 days post-transplant. Half the patients were severely neutropenic (Absolute neutrophil count = 0) at the time of diagnosis. The most common presenting symptoms were abdominal pain (80%), vomiting (50%), and fever (40%). C-reactive protein was elevated in all cases (median: 61 mg/L). While 40% of the cases were diagnosed by ultrasonography, 60% required computed tomography. All patients underwent early laparoscopic appendectomy within 24 h of diagnosis. Histopathology revealed perforated appendicitis in two patients. There were no perioperative complications. Oral feeding was resumed within 1-6 days (median: 2), and no patients experienced wound infections or surgical delays in further treatment. One patient died due to progression of underlying disease, unrelated to appendicitis.

Despite the immunosuppressed state and neutropenia, early laparoscopic appendectomy was safe and effective in pediatric HSCT recipients, supporting its use as a first-line treatment strategy in this population.