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The acute abdomen in the immunologically compromised child
Insights
Pediatric patients with leukemia, aplastic anemia, and solid tumors frequently develop acute abdominal disease. Prompt surgical evaluation and treatment are crucial for survival in these high-risk cases.
Area of Science:
- Pediatric Surgery
- Pediatric Oncology
- Gastroenterology
Background:
- Children with leukemia, aplastic anemia, and solid tumors are susceptible to acute abdominal disease.
- Cancer treatments like chemotherapy and irradiation can alter immune and hematopoietic systems, increasing abdominal complication risks.
Purpose of the Study:
- To evaluate the incidence and outcomes of acute abdominal disease in pediatric cancer patients.
- To highlight the spectrum of surgical emergencies encountered in this population.
Main Methods:
- Retrospective review of 35 pediatric patients (1976-1982) with leukemia, aplastic anemia, or solid tumors.
- Analysis of symptoms, signs, surgical interventions, and outcomes related to acute abdominal disease.
Main Results:
- 26 patients (74%) required 34 operations, 14 for life-threatening events.
- Common surgical emergencies included gastrointestinal hemorrhage, biliary tract disease, and typhlitis.
- 13 patients (37%) survived, while 22 (63%) died, 13 due to abdominal complications.
Conclusions:
- Acute abdominal complications are a significant cause of morbidity and mortality in pediatric cancer patients.
- Early, aggressive surgical intervention is essential for improving survival rates.
- Surgeons must be aware of the diverse abdominal complications in this patient group.
Abstract:
From 1976 through 1982, 35 children with leukemia (27), aplastic anemia (4), and solid tumors (4), were evaluated for symptoms and signs of acute abdominal disease. Twenty-six patients required 34 operations, 14 of them for life-threatening events. Sixteen patients received a bone marrow transplant. The most common surgical emergencies were for acute massive Gl hemorrhage (10), biliary tract disease (4), and typhlitis (3). Thirteen (37%) of the children are alive and free of disease, 22 (63%) have died, 13 of them as a direct result of the abdominal complication which occurred. Alterations in the immune system and hematopoietic system caused by the malignant disease and its treatment with chemotherapy and irradiation appears to be responsible for a number of abdominal complications which the surgeon is asked to see. When symptoms and signs of an acute abdomen develop in patients with leukemia or solid tumors, prompt, thorough evaluation and early aggressive surgical treatment is needed if the patient is to survive. The surgeon should be aware of the unusual array of abdominal complications which can occur in this population of patients.