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Conservative Management of Acute Appendicitis in Children With Hematologic Malignancies During Chemotherapy-induced Neutropenia

Wiegering, Verena A. MS*; Kellenberger, Christian J. MD; Bodmer, Nicole MD*; Bergstraesser, Eva MD*; Niggli, Felix MD*; Grotzer, Michael MD*; Nadal, David MD; Bourquin, Jean-Pierre MD, PhD*

Journal of Pediatric Hematology/Oncology: June 2008 - Volume 30 - Issue 6 - p 464-467
doi: 10.1097/MPH.0b013e318168e7cb
Clinical and Laboratory Observations

The management of acute appendicitis in the febrile neutropenic patient after intensive chemotherapy is controversial. We report our single-center–experience of 5 children diagnosed with appendicitis during febrile neutropenia after chemotherapy for acute leukemia or lymphoma. All patients presented with an isolated appendicitis without signs of overt mucositis or more diffuse enterocolitis. The clinical diagnosis was confirmed by ultrasonography. Perforation with retrocecal abscess was present in 1 patient. Administration of combination antimicrobial regimens including meropenem resulted in complete resolution in all patients. Our observations indicate that acute appendicitis in clinically stable neutropenic cancer patients can be managed conservatively without surgery.

Departments of *Pediatric Oncology

Diagnostic Imaging

Infectious Diseases, University Children's Hospital, University of Zurich, Zurich, Switzerland

Reprints: Jean-Pierre Bourquin, MD, PhD, Department of Pediatric Oncology, Universitäts-Kinderkliniken Zürich, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland (e-mail:

Received for publication October 2, 2007; accepted January 7, 2008

© 2008 Lippincott Williams & Wilkins, Inc.