Appendiceal disease in hematopoietic cell transplantation

Abstract

Appendiceal diseases are rare reported complications during hematopoietic stem cell transplantation with no guidance on management in the published literature. Medical therapy may be considered in selected patients prior to surgical solutions.

Acute Gangrenous Appendicitis in A 70-Year-Old Patient with Multiple Myeloma

“…Thinking about the imaging part and the finding, we notice that computed tomography the plasmacytes, appear as soft tissue tumors [14,15], while in the necrotic enterocolitis or cecitis, the point findings are the distention of the intestine with mucosal lesion and the increased wall thickness [7]. Likewise, the appendix in the case of patients with neutropenia, appears enlarged with increased thickness of the wall accompanied by mucosal damage [10]. Coprolith or felt can also exist.…”

“…Initially, by broad-spectrum antibiotic administration, fluids and electrolytes balance are administrated while in certain cases the injection or administration of cortisone and hematopoietic growth factors are also used [8,9]. An intriguing case in among these patients is cecitis, in which we may find inflammation expansion towards the appendix [7,10]. Cecitis or thyphlitis as it is also known is usually treated conservatively and due to the particularity of the disease, plenty of questions are raised regarding the differential diagnosis.…”

“…The major question that has to be answered, is when there is a real appendiceal infection and when the surgical treatment via exploratory laparotomy is the only option [11,12]. At the time of differential diagnosis, one of the main problems that appears is the occasion in which there is an inflammatory reaction in the appendix and the surrounding area [10][11][12][13]. Taking this into consideration, the decision for surgical invasion will be based on the clinical appearence, as well as, the imaging finding (free intraperitoneal air, intraperitoneal fluid diffusion, inflammation of the cecal base) [7].…”

“…Coprolith or felt can also exist. The existence of a certain corresponding tumor raises the suspicion of the extramedullary localization of the disease, on the wider anatomical area of the ileocecal valve, essentially when it is imagistically combined, with a soft tissue texture image [7,10,14]. This fact is due to the pathophysiological mechanism of enterocolitis, which is involved in the process of mucosal damage and ischemia, as well as, reduced lymphatic drainage [7].…”