Acute appendicitis in leukaemia patients undergoing haematopoietic stem cell transplantation during the neutropaenic phase: a case series from a single BMT centre in China

Abstract

Appendicitis is a rare but life-threatening complication in patients undergoing haematopoietic stem cell transplantation (HSCT). Infectious complications arising from the gastrointestinal tract are common in immunocompromised patients with haematologic malignances. 1,2 Serious infection often occurs in neutropaenic patients, especially during HSCT. Acute appendicitis is frequently reported in leukaemia patients after chemotherapy but is rarely reported during HSCT. The Alvarado Scoring System (the MANTRELS acronym stands for 'Migration, Anorexia-acetone, Nausea-vomiting, Tenderness in right quadrant, Reboud pain, Elevation of temperature, Leukocytosis, Shif to the left'), which is shortened to ASS-MANTRELS, has been used to diagnose acute appendicitis. 3 However, acute appendicitis occurred in HSCT patients during the neutropaenic phase. The indexes of leukocytosis and shift to the left (LS) of the ASS-MANTRELS were not applicable to these patients. Therefore, a standard criterion applicable for such patients who underwent HSCT was set up. Here we report 10 cases of acute appendicitis, which were selected from 776 sequential HSCTs.

Acute Appendicitis After Umbilical Cord Blood Transplant

“…What is the best management of acute appendicitis in the bone marrow transplant patient? A literature search revealed two letters to the editor describing 10 bone marrow transplant patients who underwent nonoperative management of acute appendicitis and two who underwent urgent appendectomy (Forghieri et al, 2008; Zhang et al, 2018). In the nonoperative group, two of the 10 patients developed E. coli sepsis, which was managed with antibiotics alone.…”