Klein Alexandra C, Rasel Hannah, Kriege Oliver, Bartsch Fabian, Lang Hauke, Lederer Ann-Kathrin
Department of General, Visceral and Transplant Surgery, University Medical Centre of the Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany.
Department of Medicine III, University Medical Centre of the Johannes Gutenberg University, 55131, Mainz, Germany.
BMC Cancer. 2025 Jul 1;25(1):1130. doi: 10.1186/s12885-025-14493-2.
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.
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.
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.
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.
急性阑尾炎是一种常见的外科急症，但由于炎症反应受损，其诊断对于血液系统恶性肿瘤患者或化疗引起的白细胞减少患者可能具有挑战性。这些患者急性阑尾炎的临床表现通常不典型，导致诊断延迟或误诊。本研究旨在评估血液系统恶性肿瘤或化疗引起白细胞减少患者阑尾切除术的结果，并评估临床评分系统在急性阑尾炎诊断中的适用性。
我们对2007年至2023年间因疑似急性阑尾炎接受阑尾切除术的血液系统恶性肿瘤或化疗相关白细胞减少患者进行了回顾性分析。回顾了临床表现、实验室检查结果和影像学结果。还评估了临床评分系统在这些患者中诊断急性阑尾炎的准确性和相关性。
我们的研究包括12例接受阑尾切除术的血液系统恶性肿瘤或化疗引起白细胞减少的患者。非典型临床表现很常见，发热、白细胞升高和其他典型炎症标志物的发生率较低。只有1例患者出现术后并发症（急性肾衰竭），没有患者因阑尾炎死亡。临床评分系统在该患者群体中的适用性有限，常常低估阑尾炎的可能性。
诊断血液系统恶性肿瘤或化疗引起白细胞减少患者的急性阑尾炎面临重大挑战，因为标准评分系统被证明不可靠。腹痛伴C反应蛋白（CRP）水平升高应促使进行多学科评估并及时进行影像学检查。手术治疗，尤其是腹腔镜手术，在这些患者中似乎是安全可行的。对于不断增加的免疫功能低下人群，持续的研究对于完善手术策略至关重要。
