Acute Appendicitis in Pediatric Hematopoietic Stem Cell Transplant Recipients: A Single-Center Experience.
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BACKGROUND: To evaluate the clinical features and outcomes of early laparoscopic appendectomy in pediatric patients who developed acute appendicitis following hematopoietic stem cell transplantation (HSCT). METHODS: This retrospective, single-center study included 10 pediatric patients diagnosed with acute appendicitis after undergoing allogeneic HSCT between 2015 and 2025. Demographics, laboratory values, imaging findings, surgical timing, and outcomes were recorded. RESULTS: Among 737 pediatric HSCT recipients, 10 patients (1.4%) developed acute appendicitis. The median age was 13 years (range: 4-16), and 80% were male. Nine patients had a diagnosis of acute lymphoblastic leukemia and one had aplastic anemia. Appendicitis was diagnosed at a median of 23.5 days post-transplant. Half the patients were severely neutropenic (Absolute neutrophil count = 0) at the time of diagnosis. The most common presenting symptoms were abdominal pain (80%), vomiting (50%), and fever (40%). C-reactive protein was elevated in all cases (median: 61 mg/L). While 40% of the cases were diagnosed by ultrasonography, 60% required computed tomography. All patients underwent early laparoscopic appendectomy within 24 h of diagnosis. Histopathology revealed perforated appendicitis in two patients. There were no perioperative complications. Oral feeding was resumed within 1-6 days (median: 2), and no patients experienced wound infections or surgical delays in further treatment. One patient died due to progression of underlying disease, unrelated to appendicitis. CONCLUSIONS: Despite the immunosuppressed state and neutropenia, early laparoscopic appendectomy was safe and effective in pediatric HSCT recipients, supporting its use as a first-line treatment strategy in this population.