Appendicitis in childhood hematologic malignancies: analysis and comparison with typhilitis.
OBJECTIVE
Recognition of appendicitis in the child with hematologic malignancy may be difficult particularly in the setting of neutropenia and multiple medications causing an altered inflammatory response. Typhilitis may produce a similar constellation of clinical findings causing further diagnostic confusion. This review compares the relative frequency of these two conditions in children with hematologic malignancy with a focus on the clinical presentation, distinguishing features, surgical management, and outcome for patients with appendicitis.


METHODS
This institutional review board-approved retrospective study evaluated 464 pediatric patients treated for hematologic malignancy at our institution from 1997 to 2003. From this cohort, we identified all children with a diagnosis of appendicitis or typhilitis. Data include demographics, clinical presentation, laboratory studies, and computed tomography (CT) scan findings. Groups were compared using the Fisher exact test. Significance was defined as P < .05.


RESULTS
Eight (1.7%) of 464 children were diagnosed with typhilitis and 7 (1.5%) with appendicitis. There were no demographic differences between patients with appendicitis and typhilitis. Distinguishing clinical features in children with typhilitis included presence of fever and diarrhea. Clinical presentation in children with appendicitis was atypical in 5 of 7 cases yielding an incorrect preoperative diagnosis in all 5. Radiographic evaluation by CT scan accurately defined typhilitis, but not appendicitis. An operation was performed on all 7 children with appendicitis with no operative morbidity or mortality.


CONCLUSIONS
Appendicitis and typhilitis occur with similar frequency in children with leukemia and lymphoma. Typhilitis is accurately diagnosed with clinical findings of fever, diarrhea, abdominal pain, and typical CT scan findings. Appendicitis tends to present with atypical findings, but can be successfully managed with standard surgical care.
Hobson
Michael J
MJ
Section of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine and the J.W. Riley Hospital for Children, Indianapolis, IN, USA.
Carney
David E
DE
Molik
Kimberly A
KA
Vik
Terry
T
Scherer
L R Tres
LR
Rouse
Thomas M
TM
West
Karen W
KW
Grosfeld
Jay L
JL
Billmire
Deborah F
DF
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D044504:Enterocolitis, Neutropenic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000188:drug therapy; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents