The acute abdomen in the immunologically compromised child

Abstract

From 1976 through 1982, 35 children with leukemia (27), aplastic anemia (4), and solid tumors (4), were evaluated for symptoms and signs of acute abdominal disease. Twenty-six patients required 34 operations, 14 of them for life-threatening events. Sixteen patients received a bone marrow transplant. The most common surgical emergencies were for acute massive Gl hemorrhage (10), biliary tract disease (4), and typhlitis (3). Thirteen (37%) of the children are alive and free of disease, 22 (63%) have died, 13 of them as a direct result of the abdominal complication which occurred. Alterations in the immune system and hematopoietic system caused by the malignant disease and its treatment with chemotherapy and irradiation appears to be responsible for a number of abdominal complications which the surgeon is asked to see. When symptoms and signs of an acute abdomen develop in patients with leukemia or solid tumors, prompt, thorough evaluation and early aggressive surgical treatment is needed if the patient is to survive. The surgeon should be aware of the unusual array of abdominal complications which can occur in this population of patients.