Surgery as a Viable Option in Neutropenic Appendicitis

A major clinical challenge in the care of children with cancer is how to take care of those patients with chemotherapy-induced neutropenia who develop acute appendicitis. How do we weigh the risk of perforation and sepsis against the risk of surgery in these high-risk patients? In this issue of Pediatrics, Many et al¹ report a 7-year retrospective review across 15 North American pediatric tertiary-level institutions comparing management strategies and outcomes for 66 children with neutropenia and image-confirmed acute appendicitis. The authors found that those who undergo appendectomy within 24 hours of diagnosis have fewer postoperative complications, shorter length of stay, and fewer delays in chemotherapy compared with those who are initially treated nonoperatively, with the worst outcomes occurring among children with a delayed appendectomy during the admission.¹ Although the sample size of this study is relatively small, the authors have amassed the largest study …

Address correspondence to Tolulope A. Oyetunji, MD, MPH, FACS, FAAP, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: taoyetunji{at}cmh.edu