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CC BY 4.0 · Indian J Med Paediatr Oncol 2024; 45(05): 402-409
DOI: 10.1055/s-0044-1786679
Original Article

Acute Appendicitis in Children with Hematological Malignancies: The Need for Early Diagnosis and Prompt Treatment—A Single-Center Case Series

Authors

  • Shruti Kakkar 

    1   Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Arihant Jain 

    2   Department of Pediatric Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Evani Jain

    3   MBBS, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Anubhavv Gupta

    4   Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Navneet Kaur

    1   Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Anirudh Jain

    3   MBBS, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Alka Grewal

    2   Department of Pediatric Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Sushil Budhiraja

    2   Department of Pediatric Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

  • Chandan Kakkar

    5   Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Abstract

Introduction Appendicitis in patients with hematological malignancies presents with vague symptoms, thus requiring a high degree of suspicion for early diagnosis and treatment to prevent complications.

Objectives The aim of this article was to describe the demographic, clinicoradiological, operative findings, and outcomes in patients with acute appendicitis with underlying hematological malignancies.

Materials and Methods A retrospective review of pediatric patients with hematological malignancy who developed acute appendicitis was conducted. Medical records of patients were reviewed for patient demographics, disease status, signs, and symptoms at the time of diagnosis of acute appendicitis, and outcome. The laboratory, radiological, and histological findings were retrieved from the hospital records.

Results Six (2.4%) patients developed acute appendicitis over the past 8 years among a total of 254 patients treated for hematological malignancies in the unit. Five patients had underlying acute lymphoblastic leukemia (ALL) and one had acute myeloid leukemia (AML). Of the five patients, three were in postremission consolidation, one each in the delayed intensification and maintenance phase of chemotherapy. The child with AML was on induction chemotherapy for the first relapse at the time of diagnosis. Fever and abdominal pain were the common presenting symptoms. Diagnosis was made on ultrasound abdomen in five patients, and one patient was diagnosed on computed tomography. All patients underwent open appendectomy. Two patients had evidence of appendiceal perforation. Three patients had neutropenia at the time of developing appendicitis and underwent appendectomy regardless of the absolute neutrophil count (ANC). Five patients recovered well, and chemotherapy was restarted within 2 weeks of appendectomy. One patient developed a superficial surgical site infection. and one patient with relapsed AML expired due to refractory septic shock.

Conclusion Acute appendicitis in patients with hematological malignancies can present with subtle signs and symptoms. Appendectomy can be safely performed irrespective of the ANC.

Keywords

acute appendicitis - hematological malignancies - neutropenia

Ethical Statement

Ethics approval has been obtained with their letter number DMCH/IEC/2023/216 dated 18/7/2023. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards mentioned in the Helsinki Declaration.


Authors' Contributions

S.K., S.B., and A.G. conceptualized the study. S.K., S.B., A.G., and A.J. designed the study. S.K., S.B., A.G., A.J., C.K., and A.G. contributed to definition of intellectual content. A.G., C.K., E.J., A.J., and N.K. helped in literature search. S.K., S.B., A.G., A.J., A.G., C.K., E.J., An.J., and N.K. were involved in clinical studies and manuscript review. E.J., An.J., and N.K. were involved in data acquisition, data analysis, statistical analysis, and manuscript editing. A.G., E.J., An.J., and N.K. contributed to manuscript preparation.


Patient's/Guardian's Consent

Not applicable.


Source of Support

None.




Publication History

Article published online:
24 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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