Acute appendicitis in adult neutropenic patients with hematologic malignancies

Forghieri, Fabio; Luppi, Mario; Narni, Franco; Morselli, Monica; Potenza, Leonardo; Bresciani, Paola; Volzone, Francesco; Rossi, Giulio; Rossi, Aldo; Trenti, Loris; Barozzi, Patrizia; Torelli, Giuseppe

doi:10.1038/bmt.2008.235

Cited by 20 publications

(17 citation statements)

References 10 publications

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“…Moreover, 2 patients had ANC of 0 at the operation. Forghieri et al 23 described their experience with 2 adult patients with hematologic malignancies (1 with multiple myeloma, the other with acute myeloid leukemia; French–American –British [FAB] classification, M2) who developed acute appendicitis while neutropenic. Both surgical procedures started laparoscopically (1 was converted to a minilaparotomy because of a gangrenous appendix) and each recovered uneventfully.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Surgery for Acute Appendicitis in Children With Cancer

Singer¹,

Stringel

Özkaynak³

et al. 2015

JSLS

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Introduction:Abdominal pain during cancer chemotherapy may be caused by medical or surgical conditions. A retrospective review of 5 children with cancer who had appendicitis while receiving chemotherapy was performed.Case Descriptions:Three had acute lymphoblastic leukemia, and 1 each had T-cell lymphoblastic lymphoma and rhabdomyosarcoma. Two of the patients had a Pediatric Appendectomy Score of 6, and 1 each had a score of 7, 5, and 2. All had evidence of appendicitis on computed tomography. Laparoscopic appendectomy was performed without any perioperative complication.Discussion:Appendicitis is an important diagnosis in children with cancer, and laparoscopic appendectomy is safe and the procedure of choice.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Surgery for Acute Appendicitis in Children With Cancer

Singer¹,

Stringel

Özkaynak³

et al. 2015

JSLS

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“…plain X ray, ultrasound and CAT scan, can be used to diagnose acute abdominal conditions and to detect potentially lethal complications. 2,10,[14][15][16][17][18][19][20][21][22] Despite the recent advances in the diagnostic techniques, there is still 37.5% error rate in the ability to accurately diagnose appendicitis particularly in children. 3,10 CAT scan is considered the diagnostic tool of choice for confirming the diagnosis of AA and differentiating it from typhlitis in cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…It is safe, reliable, accurate, non-invasive and has better sensitivity and specificity than ultrasound. 6,[20][21][22] Typhlitis is the main differential diagnosis of AA in neutropenic cancer patients. 6,[19][20][21] It presents with: fever, nausea, vomiting, right lower quadrant abdominal pain, guarding, rebound tenderness and tachycardia.…”

Section: Discussionmentioning

confidence: 99%

“…6,[20][21][22] Typhlitis is the main differential diagnosis of AA in neutropenic cancer patients. 6,[19][20][21] It presents with: fever, nausea, vomiting, right lower quadrant abdominal pain, guarding, rebound tenderness and tachycardia. The indications of surgical intervention in patients with typhlitis include: persistent and localised abdominal pain or guarding, lack of improvement with medical therapy, clinical deterioration and the development of an abdominal mass.…”

Section: Discussionmentioning

confidence: 99%

“…appendicectomy, can be safely performed and is the most effective therapeutic modality despite having leukemia and neutropenia. 2,5,6,21 Therefore, patients with leukemia having significant right lower quadrant abdominal pain and signs of peritoreal irritation should be operated upon despite having an advanced disease or having had received cytotoxic chemotherapy or steroids. 2,5,6,14 In patients with malignant hematological disorders who present with acute abdomen experience has shown that prompt diagnosis and early surgical intervention with an adequate supportive care i.e.…”

Section: Discussionmentioning

confidence: 99%

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Acute Appendicitis in Neutropenic Patients with Acute Leukemia

Al-Anazi

Al-Jasser

Daff

et al. 2010

Clinical Medicine Insights: Trauma and Intensive Medicine

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Background In neutropenic patients with acute leukemia, acute abdomen which is usually attributed to typhlitis may be encountered. However, the diagnosis of acute appendicitis is rarely described or confirmed. Methods and Materials A retrospective study of acute appendicitis in adult patients with acute leukemia was conducted at the Riyadh Armed Forces Hospital between January 1991 and December 2002 and then the study was continued at King Faisal Specialist Hospital and Research Centre in Riyadh between January 2004 and December 2006. Results Acute appendicitis developed in three out of 408 patients with acute leukemia treated at both institutions. The incidence of acute appendicitis in adult patients with acute leukemia was 0.74%. Acute appendicitis was encountered during the neutropenic periods following the courses of cytotoxic chemotherapy given to control the leukemia. The three study patients were males and they presented with the classical clinical manifestations of acute appendicitis and they underwent successful appendicectomies. The radiological investigations were helpful in confirming the clinical diagnoses. Compared to the control group of patients, the study patients developed acute leukemia at a younger age and they also had higher rates of: infectious complications, relapse and mortality but lower rate of cytogenetic abnormalities and extramedullary disease. Conclusions The development of acute appendicitis in neutropenic patients with acute leukemia is an extremely rare event. The combination of the classical clinical manifestations as well as the compatible radiological features is essential diagnostically. Taking a decision to operate on these immunocompromised patients during the periods of severe pancytopenia is a real challenge to surgeons and hematologists. However, surgical intervention may be associated with long term complications such as relapse of the leukemia, infectious complications and decreased survival.

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Inflammatory Disorders of the Appendix

Campbell¹

2012

Morson and Dawson's Gastrointestinal Pathology

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Acute appendicitis in adult neutropenic patients with hematologic malignancies

Abstract: n.d

Cited by 20 publications

References 10 publications

Laparoscopic Surgery for Acute Appendicitis in Children With Cancer

Laparoscopic Surgery for Acute Appendicitis in Children With Cancer

Acute Appendicitis in Neutropenic Patients with Acute Leukemia

Inflammatory Disorders of the Appendix

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