Surgical approach for appendicitis in neutropenia: a case report and review of the literature
Abstract Background Acute appendicitis is a common abdominal pathology, particularly in younger patients presenting with abdominal pain. The clinical presentation is typically characterized by right lower quadrant pain (with local peritonitis) accompanied by fever and nausea. In neutropenic patients...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-11-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-022-01563-x |
| _version_ | 1798016732318662656 |
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| author | Ushanthan Uthayanan Walter Kolb Bruno Schmied Stephan Bischofberger |
| author_facet | Ushanthan Uthayanan Walter Kolb Bruno Schmied Stephan Bischofberger |
| author_sort | Ushanthan Uthayanan |
| collection | DOAJ |
| description | Abstract Background Acute appendicitis is a common abdominal pathology, particularly in younger patients presenting with abdominal pain. The clinical presentation is typically characterized by right lower quadrant pain (with local peritonitis) accompanied by fever and nausea. In neutropenic patients it is challenging to diagnose acute appendicitis. It is much more challenging because the characteristic symptoms are different, and diagnosis may be delayed or missed. Case presentation We present the case of a 33-year-old Caucasian male patient with fever, abdominal pain, and an absolute granulocyte count of 0 × 109/L. Abdominal CT demonstrated an uncomplicated acute appendicitis. We initiated a conservative in-hospital treatment with intravenous antibiotic therapy and simultaneous bone marrow stimulation, with close monitoring. On day three, there was evidence of monocyte increase, one of the first signs of bone marrow regeneration, and delayed laparoscopic appendectomy was performed. The perioperative and postoperative course was uneventful. Conclusion We discuss the different treatment strategies in patients with neutropenia presenting with acute appendicitis (i.e., conservative management, delayed appendectomy, and immediate appendectomy) based on our experience and a review of the literature. In summary, delayed laparoscopic appendectomy at the onset of granulocyte regeneration under antibiotic and G-CSF therapy represents a viable surgical option for adults as well as for children and should be discussed compared with conservative therapy. |
| first_indexed | 2024-04-11T15:55:29Z |
| format | Article |
| id | doaj.art-2fac2316c51544dbadcb26c9d981ec03 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-04-11T15:55:29Z |
| publishDate | 2022-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-2fac2316c51544dbadcb26c9d981ec032022-12-22T04:15:10ZengSpringerOpenSurgical Case Reports2198-77932022-11-01811610.1186/s40792-022-01563-xSurgical approach for appendicitis in neutropenia: a case report and review of the literatureUshanthan Uthayanan0Walter Kolb1Bruno Schmied2Stephan Bischofberger3Department of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. GallenDepartment of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. GallenDepartment of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. GallenDepartment of General, Visceral, Endocrine and Transplant Surgery, Kantonsspital St. GallenAbstract Background Acute appendicitis is a common abdominal pathology, particularly in younger patients presenting with abdominal pain. The clinical presentation is typically characterized by right lower quadrant pain (with local peritonitis) accompanied by fever and nausea. In neutropenic patients it is challenging to diagnose acute appendicitis. It is much more challenging because the characteristic symptoms are different, and diagnosis may be delayed or missed. Case presentation We present the case of a 33-year-old Caucasian male patient with fever, abdominal pain, and an absolute granulocyte count of 0 × 109/L. Abdominal CT demonstrated an uncomplicated acute appendicitis. We initiated a conservative in-hospital treatment with intravenous antibiotic therapy and simultaneous bone marrow stimulation, with close monitoring. On day three, there was evidence of monocyte increase, one of the first signs of bone marrow regeneration, and delayed laparoscopic appendectomy was performed. The perioperative and postoperative course was uneventful. Conclusion We discuss the different treatment strategies in patients with neutropenia presenting with acute appendicitis (i.e., conservative management, delayed appendectomy, and immediate appendectomy) based on our experience and a review of the literature. In summary, delayed laparoscopic appendectomy at the onset of granulocyte regeneration under antibiotic and G-CSF therapy represents a viable surgical option for adults as well as for children and should be discussed compared with conservative therapy.https://doi.org/10.1186/s40792-022-01563-xAppendicitisNeutropeniaG-CSFAppendectomyCase report |
| spellingShingle | Ushanthan Uthayanan Walter Kolb Bruno Schmied Stephan Bischofberger Surgical approach for appendicitis in neutropenia: a case report and review of the literature Surgical Case Reports Appendicitis Neutropenia G-CSF Appendectomy Case report |
| title | Surgical approach for appendicitis in neutropenia: a case report and review of the literature |
| title_full | Surgical approach for appendicitis in neutropenia: a case report and review of the literature |
| title_fullStr | Surgical approach for appendicitis in neutropenia: a case report and review of the literature |
| title_full_unstemmed | Surgical approach for appendicitis in neutropenia: a case report and review of the literature |
| title_short | Surgical approach for appendicitis in neutropenia: a case report and review of the literature |
| title_sort | surgical approach for appendicitis in neutropenia a case report and review of the literature |
| topic | Appendicitis Neutropenia G-CSF Appendectomy Case report |
| url | https://doi.org/10.1186/s40792-022-01563-x |
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