Treatment of appendicitis in neutropenic children

Abstract

Background: Appendicitis in the neutropenic patient places the clinician in a precarious position; balancing the timing and risks of surgery and the risk of an uncontrolled infectious source in the abdomen.

Methods: Multi-center retrospective review from 2000 to 2010 of appendicitis occurring in patients with neutropenia secondary to chemotherapy. Patient demographics and surgical outcomes were tracked.

Results: There were 11 patients, mean age of 11 y (3-17 y); six were male. Mean weight was 46.9 kg (18.1-72.6 kg). Mean body mass index was 20.9 kg/m(2) (16.8-27.3 kg/m(2)). There were five acute lymphocytic leukemias, four acute myeloblastic leukemias, one T-Cell lymphoma, and one Ewing's sarcoma. Mean presenting white blood cell count was 1900 (0.2-4.4). Average absolute neutrophil count was 900 (0.00-2.6). Computed tomography scan was used in all patients. Appendectomy was performed within 24 h of presentation in all patients, three were perforated. Mean time to first feeding was 1 d (range, 0-5 d), goal feeds at 3 d (range, 1-6 d ). Mean length of stay from appendicitis was 4 d.

Conclusion: Early appendectomy for appendicitis in neutropenic patients appears to be tolerated well with a low risk of surgical complications.