Appendicitis in a Neutropenic Patient: A Multicentric Retrospective Study

Abstract

To study the management of acute appendicitis in neutropenic patients, we retrospectively reviewed cases of acute appendicitis in neutropenic children treated for cancer. The patients' demographics, medical records, and outcomes were tracked. We compared nonoperative treatment versus emergency or delayed surgery. The cases of 30 patients with a mean age of 8.8 years in 12 French departments of Pediatric Hematology/Oncology between 1995 and 2013 were studied. Most patients (90%) were treated for hematological malignancies. Seven of the 30 children were successfully treated with exclusive medical treatment. Early surgery was performed in 6 patients, and the remaining 17 underwent combined management with a first-line antibiotic treatment and delayed appendectomy. Treatments were successful in all cases with transitory complications in only 3 patients. No death linked to infection was reported. Surgery was well tolerated even in the neutropenic period. Appendix perforation was a major risk factor of prolonged hospitalization. Histologic as well as bacteriologic and mycologic/parasitologic analyses were required in case of surgery. Analysis of diagnostic assessments showed the major importance of imaging (ultrasonography and tomography) on diagnosis confirmation. We could not come to a conclusion in the few numbers of reviewed cases because of a significant difference in management strategies, but we can conclude that early surgery after adequate supportive care is an acceptable modality of treatment and must be chosen in the face of life-threatening conditions.

Appendectomy Versus Observation for Appendicitis in Neutropenic Children With Cancer

“…As a result, there is providerdependent variation in treatment strategies, ranging from upfront surgery (surgery within 24 hours) and nonoperative management to initial nonoperative management, with delayed appendectomy after count recovery. 7 Variation in management strategies for NA may lead to delay or changes in cancer therapies and potentially even differences in oncologic outcome.…”

Comparison between early surgical treatment and conservative treatment of appendicitis in cancer patients

“…There are few studies on the treatment of appendicitis in patients with cancer. However, our study included a larger number of patients compared to previous studies that involved fewer cases 21–23 . Based on our results, we suggest that early surgical treatment would be more effective than conservative treatment for appendicitis in cancer patients.…”

Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review

“…All the therapeutic approaches were successful, and transitory complications were noted in only three patients. The length of hospital stay (mean, 20 days) was not associated with the treatment method [15].…”

“…Conservative management avoids the risks associated with postoperative complications in these patients. However, a longer period is necessary for complete recovery, and the chances for clinical worsening, perforation, and recurrence are greater [15]. A delay in recovery from appendicitis can also lead to a delay in resuming chemotherapy, which can worsen the patient's underlying illness and escalate medical costs [2].…”