Work

Acute appendicitis in patients suffering from Immunocompromising hematologic malignancies or chemotherapy-related leukopenia: a cohort study

Year: 2025

Type: article

Abstract: BACKGROUND: Acute appendicitis is a common surgical emergency, but its diagnosis can be challenging in patients with hematologic malignancies or chemotherapy-induced leukopenia due to an impaired inflammatory response. The clinical presentation of acute appendicitis in these patients is often atypical, leading to delayed or misdiagnosis. This study aims to evaluate the outcomes of appendectomy in patients with hematologic malignancies or chemotherapy-induced leukopenia and assess the applicability of clinical scoring systems for the diagnosis of an acute appendicitis. METHODS: We conducted a retrospective analysis of patients with hematologic malignancies or chemotherapy-related leukopenia who underwent appendectomy for suspected acute appendicitis between 2007 and 2023. Clinical presentation, laboratory findings, and imaging results were reviewed. The accuracy and relevance of clinical scoring systems for diagnosing acute appendicitis in these patients were also evaluated. RESULTS: Our study included 12 patients with hematologic malignancies or chemotherapy-induced leukopenia who underwent appendectomy. Atypical clinical presentations were common, with a lower frequency of fever, elevated leukocytes, and other typical inflammatory markers. Only one patient developed postoperative complications (acute kidney failure), and none of the patients died due to appendicitis. Clinical scoring systems demonstrated limited applicability in this patient population, often underestimating the likelihood of appendicitis. CONCLUSION: Diagnosing acute appendicitis in patients with hematologic malignancies or chemotherapy-induced leukopenia poses significant challenges, as standard scoring systems prove unreliable. The presence of abdominal pain coupled with elevated C-reactive protein (CRP) levels should prompt a multidisciplinary evaluation and timely imaging. Surgical therapies, particularly laparoscopic approaches, appear safe and feasible in these patients. Ongoing research is essential to refine surgical strategies for the growing population of immunocompromised individuals.

Source: BMC Cancer

DOI: 10.1186/s12885-025-14493-2

Authors: Alexandra C. Klein, Hannah Rasel, Oliver Kriege, Fabian Bartsch, Hauke Lang, Ann-Kathrin Lederer

Institutions: Johannes Gutenberg University Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Krankenhaus der Barmherzigen Brüder Trier

Language: English

Topic: Appendicitis Diagnosis and Management

Subfield: Emergency Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,390