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Abdominal Complications During Treatment for Pediatric Acute Myeloid Leukemia. J Pediatr Hematol Oncol 2022; 44:220-229. [PMID: 34387627 DOI: 10.1097/mph.0000000000002281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Acute myeloid leukemia (AML) accounts for 15% to 20% of childhood leukemias. Because of high-intensive therapy, up to 5% of patients suffer from treatment-related mortality (TRM). Abdominal complications are frequent, however, literature on this subject is sparse. We aimed to characterize severe abdominal pain (AP) and hyperbilirubinemia experienced by pediatric AML patients treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO)-AML 2004 protocol (n=313). Patients were censored at hematopoietic stem cell transplantation and relapse. Toxicity information was collected prospectively. Additional information was requested retrospectively from the treating centers. Sixteen episodes of hyperbilirubinemia and 107 episodes of AP were reported. The treating centers deemed infection (30%) and typhlitis (18%) as the most frequent causes of AP. Six patients developed appendicitis (2%). Patients experiencing concurrent AP and sepsis had a high risk of TRM (36%, n=4). Eighty percent of episodes with hyperbilirubinemia fulfilled the European Society for Bone and Marrow Transplantation criteria for sinusoidal obstruction syndrome. In conclusion, abdominal complications were frequent with infection considered the predominate cause. Most patients with hyperbilirubinemia fulfilled the criteria for sinusoidal obstruction syndrome. AML treatment might be associated with appendicitis. Patients suffering from concurrent AP and sepsis had a high risk of TRM indicating that high awareness of abdominal complications is essential to reduce mortality, especially during sepsis.
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Koluman B, Aykota M. Appendectomy challenge if there is not neutrophil! JOURNAL OF APPLIED HEMATOLOGY 2021. [DOI: 10.4103/joah.joah_193_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ali A, Alhindi S, Alalwan AA. Acute Appendicitis in a Child With Acute Leukemia and Chemotherapy-Induced Neutropenia: A Case Report and Literature Review. Cureus 2020; 12:e8858. [PMID: 32617245 PMCID: PMC7325351 DOI: 10.7759/cureus.8858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute appendicitis is a rare but important complication in children with leukemia. It can be difficult to diagnose, and it has a complicated disease course, especially in patients receiving chemotherapy. Awareness of these complications is critical, particularly in cases where surgical intervention is required. We report a child with T-cell acute lymphoblastic leukemia and chemotherapy-induced neutropenia who presented with acute appendicitis. He was successfully treated with broad-spectrum empiric antibiotics and a delayed laparoscopic appendectomy.
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Affiliation(s)
- Alaa Ali
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
| | - Saeed Alhindi
- Pediatric Surgery, Salmaniya Medical Complex, Manama, BHR
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Saillard C, Zafrani L, Darmon M, Bisbal M, Chow-Chine L, Sannini A, Brun JP, Ewald J, Turrini O, Faucher M, Azoulay E, Mokart D. The prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis: a systematic review and meta-analysis, on behalf the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH). Ann Intensive Care 2018; 8:47. [PMID: 29675758 PMCID: PMC5908777 DOI: 10.1186/s13613-018-0394-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/12/2018] [Indexed: 12/15/2022] Open
Abstract
Neutropenic enterocolitis (NE) is a diagnostic and therapeutic challenge associated with high mortality rates, with controversial opinions on its optimal management. Physicians are usually reluctant to select surgery as the first-choice treatment, concerns being raised regarding the potential risks associated with abdominal surgery during neutropenia. Nevertheless, no published studies comforted this idea, literature is scarce and surgery has never been compared to medical treatment. This review and meta-analysis aimed to determine the prognostic impact of abdominal surgery on outcome of neutropenic cancer patients presenting with NE, versus medical conservative treatment. This meta-analysis included studies analyzing cancer patients presenting with NE, treated with surgical or medical treatment, searched by PubMed and Cochrane databases (1983–2016), according to PRISMA recommendations. The endpoint was hospital mortality. Fixed-effects models were used. The meta-analysis included 20 studies (385 patients). Overall estimated mortality was 42.2% (95% CI = 40.2–44.2). Abdominal surgery was associated with a favorable outcome with an OR of 0.41 (95% CI = 0.23–0.74; p = 0.003). Pre-defined subgroups analysis showed that neither period of admission, underlying malignancy nor neutropenia during the surgical procedure, influenced this result. Surgery was not associated with an excess risk of mortality compared to medical treatment. Defining the optimal indications of surgical treatment is needed. Trial registration PROSPERO CRD42016048952
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Affiliation(s)
- Colombe Saillard
- Haematology Department, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille Cedex 09, France.
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Michael Darmon
- Medical-Surgical Intensive Care Unit, Hôpital Nord, Université Jean Monnet, Saint Etienne, France.,GRRR-OH (Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie), Paris, France
| | - Magali Bisbal
- GRRR-OH (Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie), Paris, France.,Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Antoine Sannini
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Jean-Paul Brun
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Jacques Ewald
- Surgery Department, Institut Paoli Calmettes, Marseille, France
| | - Olivier Turrini
- Surgery Department, Institut Paoli Calmettes, Marseille, France
| | - Marion Faucher
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.,GRRR-OH (Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie), Paris, France.,Faculté de Médecine, Université Paris Diderot, Sorbonne-Paris-Cité, Paris, France
| | - Djamel Mokart
- GRRR-OH (Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie), Paris, France.,Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
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Abstract
To study the management of acute appendicitis in neutropenic patients, we retrospectively reviewed cases of acute appendicitis in neutropenic children treated for cancer. The patients' demographics, medical records, and outcomes were tracked. We compared nonoperative treatment versus emergency or delayed surgery. The cases of 30 patients with a mean age of 8.8 years in 12 French departments of Pediatric Hematology/Oncology between 1995 and 2013 were studied. Most patients (90%) were treated for hematological malignancies. Seven of the 30 children were successfully treated with exclusive medical treatment. Early surgery was performed in 6 patients, and the remaining 17 underwent combined management with a first-line antibiotic treatment and delayed appendectomy. Treatments were successful in all cases with transitory complications in only 3 patients. No death linked to infection was reported. Surgery was well tolerated even in the neutropenic period. Appendix perforation was a major risk factor of prolonged hospitalization. Histologic as well as bacteriologic and mycologic/parasitologic analyses were required in case of surgery. Analysis of diagnostic assessments showed the major importance of imaging (ultrasonography and tomography) on diagnosis confirmation. We could not come to a conclusion in the few numbers of reviewed cases because of a significant difference in management strategies, but we can conclude that early surgery after adequate supportive care is an acceptable modality of treatment and must be chosen in the face of life-threatening conditions.
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Mokart D, Penalver M, Chow-Chine L, Ewald J, Sannini A, Brun JP, Bisbal M, Lelong B, Delpero JR, Faucher M, Turrini O. Surgical treatment of acute abdominal complications in hematology patients: outcomes and prognostic factors. Leuk Lymphoma 2017; 58:2395-2402. [DOI: 10.1080/10428194.2017.1296145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Djamel Mokart
- Réanimation Polyvalente et Département d’Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Marion Penalver
- Réanimation Polyvalente et Département d’Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Réanimation Polyvalente et Département d’Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Jacques Ewald
- Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
| | - Antoine Sannini
- Réanimation Polyvalente et Département d’Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Jean Paul Brun
- Réanimation Polyvalente et Département d’Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Magali Bisbal
- Réanimation Polyvalente et Département d’Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Bernard Lelong
- Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
| | - Jean Robert Delpero
- Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
| | - Marion Faucher
- Réanimation Polyvalente et Département d’Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Olivier Turrini
- Département de Chirurgie Oncologique, Institut Paoli-Calmettes, Marseille, France
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Rodriguez EA, Lopez MA, Valluri K, Wang D, Fischer A, Perdomo T. Acute appendicitis secondary to acute promyelocytic leukemia. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:73-6. [PMID: 25666852 PMCID: PMC4327184 DOI: 10.12659/ajcr.892760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patient: Female, 43 Final Diagnosis: Myeloid sarcoma appendicitis Symptoms: Abdominal pain • chills • fever Medication: — Clinical Procedure: Laparoscopic appendectomy, bone marrow biopsy Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Eduardo A Rodriguez
- Department of Internal Medicine, University of Miami Palm Beach Regional Campus, Atlantis, FL, USA
| | - Marvin A Lopez
- Department of Internal Medicine, University of Miami Palm Beach Regional Campus, Atlantis, FL, USA
| | - Kartik Valluri
- Department of Internal Medicine, University of Miami Palm Beach Regional Campus, Atlantis, FL, USA
| | - Danlu Wang
- Department of Internal Medicine, University of Miami Palm Beach Regional Campus, Atlantis, FL, USA
| | - Andrew Fischer
- Department of Internal Medicine, University of Miami Palm Beach Regional Campus, Atlantis, FL, USA
| | - Tatiana Perdomo
- Department of Pathology, JFK Medical Center, Atlantis, FL, USA
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Acute myeloid leukemia presenting as acute appendicitis. Case Rep Hematol 2013; 2013:815365. [PMID: 23840984 PMCID: PMC3693109 DOI: 10.1155/2013/815365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/02/2013] [Indexed: 11/17/2022] Open
Abstract
Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.
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Clinical manifestations of acute appendicitis in hemodialysis patients. Surg Today 2012; 43:977-83. [PMID: 23052740 DOI: 10.1007/s00595-012-0349-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 07/03/2012] [Indexed: 01/07/2023]
Abstract
PURPOSE Acute appendicitis has been suggested to be more aggravated in hemodialysis (HD) patients in comparison to non-HD patients but only scanty evidence demonstrates the conditions. METHODS A retrospective cohort study was done for HD and non-HD patients with a discharge diagnosis of acute appendicitis in a single medical center. RESULTS Patients with acute appendicitis on HD (n = 11), and non-HD (n = 40) were enrolled. The patients in the HD group, demonstrated older age, less leukocytosis, shorter preoperative diagnostic delay, but with no improvement of perforation rate and poor prognosis such as longer hospital stay and higher morbidity rate in comparison to the non-HD group. The differences between the HD and non-HD group still existed even with an age- and gender-matched non-HD group. A higher C-reactive protein level was a helpful index in early diagnosis and predicting the possibility of perforation. Hyponatremia was an important prognostic factor associated with a longer preoperative delay, longer hospital stay and higher morbidity rate in the HD group. CONCLUSIONS The diagnosis of AA in HD patients was earlier than in non-HD patients. HD patients with AA had atypical presentations and a poor prognosis especially those that presented with hyponatremia and a perforated appendicitis. Higher C-reactive protein was associated with the development of perforated appendicitis in HD patients.
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Mortellaro VE, Juang D, Fike FB, Saites CG, Potter DD, Iqbal CW, Snyder CL, St. Peter SD. Treatment of Appendicitis in Neutropenic Children. J Surg Res 2011; 170:14-6. [PMID: 21514602 DOI: 10.1016/j.jss.2011.03.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/07/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
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Hsiao PJ, Kuo SM, Chen JH, Lin HF, Chu PL, Lin SH, Ho CL. Acute myelogenous leukemia and acute leukemic appendicitis: A case report. World J Gastroenterol 2009; 15:5624-5. [PMID: 19938205 PMCID: PMC2785068 DOI: 10.3748/wjg.15.5624] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute myelogenous leukemia (AML) can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leukemia relapse. Pathological findings of the appendix revealed transmural infiltrates of myeloblasts, which indicated a diagnosis of leukemia. Unfortunately, the patient died from progression of the disease on the 19th d after admission. Although leukemic cell infiltration of the appendix is uncommon, patients with leukemia relapse can present with symptoms mimicking acute appendicitis.
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Palomino-Portilla EA, Valbuena JR, Quinones-Avila MDP, Medeiros LJ. Myeloid sarcoma of appendix mimicking acute appendicitis. Arch Pathol Lab Med 2005; 129:1027-31. [PMID: 16048393 DOI: 10.5858/2005-129-1027-msoama] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Myeloid sarcoma is a neoplasm of immature myeloid cells involving an extramedullary anatomic site that is usually, although not always, associated with acute myeloid leukemia. Any extramedullary site can be involved by myeloid sarcoma, but involvement of the cecal appendix is uncommon, and symptoms mimicking acute appendicitis as a result of appendiceal involvement are rare. OBJECTIVE To describe the clinicopathologic features of 2 patients with myeloid sarcoma involving the appendix who presented with right lower quadrant pain suggestive of acute appendicitis and prompting appendectomy. DESIGN Clinical information for both patients was obtained from the medical record. Routine hematoxylin-eosin-stained slides, naphthol-ASD-chloroacetate stain, and immunohistochemical stains for myeloid, B-cell, and T-cell antigens were prepared. RESULTS Peripheral blood and bone marrow were infiltrated by coexistent acute myeloid leukemia in case 1 but were negative for leukemia in case 2. In case 2, the patient had a history of acute myeloid leukemia that had been treated by an allogenic bone marrow transplant 7 months earlier. Histologic examination of the appendix revealed poorly differentiated myeloid sarcoma in both cases. Each neoplasm was positive for chloroacetate esterase, myeloperoxidase, lysozyme, and CD43 and was negative for CD3 and CD20. CONCLUSIONS Myeloid sarcoma involving the appendix can rarely cause pain or other symptoms mimicking acute appendicitis. A high index of suspicion combined with the use of cytochemical and immunohistochemical studies are helpful in establishing the diagnosis.
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Hohenberger P, Buchheidt D. Surgical interventions in patients with hematologic malignancies. Crit Rev Oncol Hematol 2005; 55:83-91. [PMID: 15886009 DOI: 10.1016/j.critrevonc.2005.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Revised: 02/25/2005] [Accepted: 03/11/2005] [Indexed: 11/27/2022] Open
Abstract
While surgery is not a part of treatment of hematological malignancies a significant number of patients suffering from such diseases need to undergo surgical interventions. These may comprise of very minor procedures such port implantation, however, already the indication for appendicectomy could be a difficult scenario being influenced by the underlying disease and side effects of the treatment. Often septic foci need to be cleared prior to start of systemic treatment. Out of the really major problems, the surgical resection of aspergillomas represent a demanding task accompanied by significant morbidity and mortality. Emergency situations sometimes are induced by treatment such as necrotizing enterocolitis but sometimes are mimicked by drug-induced abdominal symptoms. An experienced team of surgical and medical oncologists is required for successful management. As the number of long-term surviving patients increases, secondary problems as aseptic bone necrosis need to be addressed and adequately handled. Even at this stage it might be difficult to assess the patients risk for open-heart surgery adequately. This group of patients if scheduled for any operative intervention needs to undergo a very careful selection process and perfect perioperative management to make sure that the result of surgery are excellent and do not compromise further medical treatment of the underlying disease.
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Affiliation(s)
- Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany.
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McCarville MB, Thompson J, Li C, Adelman CS, Lee MO, Alsammarae D, May MV, Jones SC, Rao BN, Sandlund JT. Significance of appendiceal thickening in association with typhlitis in pediatric oncology patients. Pediatr Radiol 2004; 34:245-9. [PMID: 14722695 DOI: 10.1007/s00247-003-1122-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2003] [Revised: 10/22/2003] [Accepted: 11/12/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The management of pediatric oncology patients with imaging evidence of appendiceal thickening is complex because they are generally poor surgical candidates and often have confounding clinical findings. OBJECTIVE We sought to determine the significance of appendiceal thickening in pediatric oncology patients who also had typhlitis. Specifically, we evaluated the impact of this finding on the duration of typhlitis, its clinical management, and outcome. MATERIALS AND METHODS From a previous review of the management of typhlitis in 90 children with cancer at our institution, we identified 4 with imaging evidence of appendiceal thickening. We compared colonic wall measurements, duration of typhlitis symptoms, management, and outcome of patients with appendiceal thickening and typhlitis to patients with typhlitis alone. RESULTS There was no significant difference in duration of typhlitis symptoms between patients with typhlitis only (15.6+/-1.2 days) and those with typhlitis and appendiceal thickening (14.5+/-5.8 days; P=0.9). Two patients with appendiceal thickening required surgical treatment for ischemic bowel, and two were treated medically. Only one patient in the typhlitis without appendiceal thickening group required surgical intervention. There were no deaths in children with appendiceal thickening; two patients died of complications of typhlitis alone. CONCLUSION Our findings suggest that appendiceal thickening does not predict a prolonged course of typhlitis in pediatric oncology patients, but it may indicate an increased risk of serious complications from this disease process.
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Affiliation(s)
- M Beth McCarville
- Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105-2794, USA.
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