title: Acute appendicitis presenting as pneumoperitoneum in a teenage boy undergoing chemotherapy.
abstract: Chemotherapy of paediatric haematological malignancies can induce infectious complications of the gastrointestinal tract, with predilection of the ileocaecal region. Common causes of right lower abdominal pain in the febrile patient with neutropaenia include acute appendicitis, typhlitis, ileus and intussusception. In this case report, we describe a teenage boy with acute appendicitis presenting with pneumoperitoneum during his course of chemotherapy. The incidence, aetiology, diagnosis, investigations and management of this uncommon presentation in a common disease are discussed. The controversial topic of the management of acute appendicitis in a febrile patient with neutropaenia is also reviewed and discussed.
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: C W Y
authors.identifier: http://orcid.org/0000-0001-8723-0594
authors.initials: CW
authors.lastname: Wong
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: P H Y
authors.initials: PH
authors.lastname: Chung
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: L C L
authors.initials: LC
authors.lastname: Lan
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: K K Y
authors.initials: KK
authors.lastname: Wong
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced / Q000209:etiology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001062:Appendectomy; D001064:Appendicitis / Q000139:chemically induced / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D003937:Diagnosis, Differential; D005334:Fever; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D000077731:Meropenem; D011027:Pneumoperitoneum / Q000175:diagnosis*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D013845:Thienamycins / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem