Treatment of Acute Appendicitis in the Patients With Severe Neutropenia

Abstract

When appendicitis occurs in neutropenic adult patients, clinicians must balance the timing and the risks of surgery. Urgent surgery may lead to high operative complications and mortality. This case report details the treatment of appendicitis in neutropenic patients with hematologic disease. Patient 1 was a 31 years old female with severe aplastic anemia and patient 2 was a 34 years old male with AML M6. Both patients' abdominal CT scan was suggestive of appendicitis. We prepared supportive care first, delayed surgery was successfully completed without acute or late complications. We suggest that, in patients in a neutropenic state, delayed elective operation is superior to urgent operation, except in the case of lifethreatening complications such as peritonitis.

Surgical approach for appendicitis in neutropenia: a case report and review of the literature

“…The prior/simultaneous application of G-CSF in this therapy regimen is controversial and has been described in various case reports [13,14]. The success of bone marrow stimulation with G-CSF is initially shown by an increase in monocytes, which undergo a faster differentiation from the myeloid stem cells than neutrophil granulocytes [15].…”