title: Significance of appendiceal thickening in association with typhlitis in pediatric oncology patients.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105-2794, USA. beth.mccarville@stjude.org
authors.forename: M Beth
authors.initials: MB
authors.lastname: McCarville
authors.forename: Janell
authors.initials: J
authors.lastname: Thompson
authors.forename: Chenghong
authors.initials: C
authors.lastname: Li
authors.forename: C Scott
authors.initials: CS
authors.lastname: Adelman
authors.forename: Moon O
authors.initials: MO
authors.lastname: Lee
authors.forename: Dania
authors.initials: D
authors.lastname: Alsammarae
authors.forename: Martha V
authors.initials: MV
authors.lastname: May
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Jones
authors.forename: Bhaskar N
authors.initials: BN
authors.lastname: Rao
authors.forename: John T
authors.initials: JT
authors.lastname: Sandlund
mesh_terms: D000293:Adolescent; D000328:Adult; D001065:Appendix / Q000000981:diagnostic imaging*; D001837:Body Weights and Measures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D044504:Enterocolitis, Neutropenic / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography