Sun Daang,Yu Kechi,Yang Fengjie,et al.Diagnosis and treatment of acute abdomen in children with hematologic malignancies[J].Journal of Clinical Pediatric Surgery,,():472-476.[doi:10.3760/cma.j.cn101785-202412033]
Diagnosis and treatment of acute abdomen in children with hematologic malignancies
- Keywords:
- Hematologic Malignancies; Acute Abdomen; Treatment; Child
- Abstract:
- Objective Toexplore the clinical characteristics of hematologic malignancies complicated by acute abdomen in children and establish its standardized management protocols.Methods From January 2010 to June 2024,retrospective analysis was conducted for the relevant clinical data of 40 children hospitalized with hematological malignancies complicated by acute abdomen.General patient profiles,type of primary disease,clinical manifestations and types of acute abdomen,management approaches and treatment outcomes were explored.Results There were 35 boys and 5 girls with a median age of 5.3(1.7-14) year.The major types of hematologic malignancies were acute lymphoblastic leukemia (n=20,50.0%) and acute myeloid leukemia (n=9,22.5%).The predominant clinical manifestations of acute abdomen were localized right lower quadrant pain (n=30,75.0%),fever (n=17,42.5%) and nausea/vomiting (n=15,37.5%).Acute appendicitis (including appendiceal abscess) (62.5%) and intestinal obstruction (22.5%) were the most common types.Based upon clinical status,23 children (57.5%) underwent emergency surgery,4 cases (10.0%) received ultrasound-guided abdominal paracentesis and drainage and the remainders (32.5%) were treated conservatively.In surgery group,cure rate for acute abdomen was 91.3%(21/23) with 2 in-hospital deaths (8.7%).In drainage group,all 4 cases had drains removed within 2 weeks post-procedure with a complete resolution of acute abdomen symptoms.All 13 cases in conservative treatment group were cured after anti-infective and symptomatic regimens.Conclusion For children with hematologic malignancies,a proper management of acute abdomen is rather complex so that a multidisciplinary approach is required.Complete intestinal obstruction and gastrointestinal perforation necessitate prompt surgical interventions while localized appendicitis and intra-abdominal abscesses may be managed with ultrasound-guided percutaneous abdominal drainage or intravenous antibiotics.
References:
[1] Gan WT, Zhang WN, Cai JY, et al.A multicenter study of acute abdomen in children with acute lymphoblastic leukemia:CCCG-ALL-2015[J].Cancer Med, 2025, 14(16):e71090.DOI:10.1002/cam4.71090.
[2] 中国医师协会外科医师分会, 中国医师协会外科医师分会肿瘤外科医师委员会, 中国医师协会外科医师分会多学科综合治疗专业委员会.恶性肿瘤相关急腹症多学科管理中国专家共识[J].中华胃肠外科杂志, 2020, 23(5):421-437.DOI:10.3760/cma.j.cn.441530-20200330-00170. Chinese College of Surgeons, Cancer Surgery Committee of Chinese College of Surgeons, Multidisciplinary Team Committee of Chinese College of Surgeons.Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen[J].Chin J Gastrointest Surg, 2020, 23(5):421-437.DOI:10.3760/cma.j.cn.441530-20200330-00170.
[3] 中华医学会儿科学分会肿瘤学组, 中华医学会儿科学分会血液学组, 中国抗癌协会小儿肿瘤专业委员会, 等.儿童和青少年侵袭性成熟B细胞非霍奇金淋巴瘤诊疗专家共识[J].中华儿科杂志, 2020, 58(10):790-795.DOI:10.3760/cma.j.cn112140-20200723-00745. The Subspecialty Group of Oncology, the Society of Pediatrics, Chinese Medical Association, the Subspecialty Group of Hematology, the Society of Pediatrics, Chinese Medical Association, Pediatric Oncology Committee, China Anti-Cancer Association, et al.Experts consensus on current management of children and adolescents with aggressive mature B-cell non-Hodgkin lymphoma[J].Chin J Pediatr, 2020, 58(10):790-795.DOI:10.3760/cma.j.cn112140-20200723-00745.
[4] 中国医师协会儿科医师分会儿童血液肿瘤学组, 中华医学会儿科学分会血液学组, 中华医学会儿科学分会肿瘤学组, 等.儿童急性髓系白血病诊疗专家共识(2024)[J].中华儿科杂志, 2024, 62(10):909-919.DOI:10.3760/cma.j.cn112140-20240722-00500. The Subspecialty Group of Pediatric Hematology and Oncology, Pediatric Medical Doctor Society of the Chinese Medical Doctor Association, the Subspecialty Group of Hematology, the Society of Pediatrics, Chinese Medical Association, the Subspecialty Group of Oncology, the Society of Pediatrics, Chinese Medical Association, et al.Expert consensus on the diagnosis and treatment of pediatric acute myeloid leukemia (2024)[J].Chin J Pediatr, 2024, 62(10):909-919.DOI:10.3760/cma.j.cn112140-20240722-00500.
[5] Sogbodjor LA, Singleton G, Davenport M, et al.Quality metrics for emergency abdominal surgery in children:a systematic review[J].Br J Anaesth, 2022, 128(3):522-534.DOI:10.1016/j.bja.2021.10.045.
[6] 王亮, 王忠荣, 徐兵, 等.小儿血液系统恶性疾病合并外科急腹症的诊治分析[J].临床小儿外科杂志, 2013, 12(4):311-313.DOI:10.3969/j.issn.1671-6353.2013.04.016. Wang L, Wang ZR, Xu B, et al.An approach to clinical treatment for acute abdomen complicated with malignant hematopathy in children[J].DOI:10.3969/j.issn.1671-6353.2013.04.016.
[7] Pagliaro L, Chen SJ, Herranz D, et al.Acute lymphoblastic leukaemia[J].Nat Rev Dis Primers, 2024, 10(1):41.DOI:10.1038/s41572-024-00525-x.
[8] Morota K, Shimizu M, Sugitate R, et al.Sudden unexpected death caused by infantile acute lymphoblastic leukaemia[J].Oxf Med Case Reports, 2021, 2021(8):omab073.DOI:10.1093/omcr/omab073.
[9] 余克驰, 冯杰雄, 魏明发, 等.儿童原发性胃肠道肿瘤外科诊治探讨[J].中华小儿外科杂志, 2015, 36(1):36-39.DOI:10.3760/cma.j.issn.0253-3006.2015.01.009. Yu KC, Feng JX, Wei MF, et al.Diagnosis and surgical treatment of primary gastrointestinal tumors in children[J].Chin J Pediatr Surg, 2015, 36(1):36-39.DOI:10.3760/cma.j.issn.0253-3006.2015.01.009.
[10] Coccolini F, Improta M, Sartelli M, et al.Acute abdomen in the immunocompromised patient:WSES, SIS-E, WSIS, AAST, and GAIS guidelines[J].World J Emerg Surg, 2021, 16(1):40.DOI:10.1186/s13017-021-00380-1.
[11] Majumder A, Misra S, Kumar V, et al.Intussusception in a child with Acute Lymphoblastic Leukemia:a remarkable presentation with literature review -a case report[J].J Egypt Natl Canc Inst, 2021, 33(1):18.DOI:10.1186/s43046-021-00079-z.
[12] Qasrawi A, Abu Ghanimeh M, Abughanimeh O, et al.Intussusception:a rare complication in a patient with acute leukaemia after consolidation chemotherapy[J].BMJ Case Rep, 2017, 2017:bcr2016218683.DOI:10.1136/bcr-2016-218683.
[13] 陈巍, 张廷冲, 王大勇, 等.伴中性粒细胞缺乏症的恶性肿瘤患儿罹患急性阑尾炎的临床特点及治疗策略[J].中华实用儿科临床杂志, 2024, 39(10):766-769.DOI:10.3760/cma.j.cn101070-20240411-00225. Chen W, Zhang TC, Wang DY, et al.Clinical features and treatment strategies of acute appendicitis in children with malignant tumors and neutropenia[J].Chin J Appl Clin Pediatr, 2024, 39(10):766-769.DOI:10.3760/cma.j.cn101070-20240411-00225.
[14] Mimery AH, Jabbour J, Sykes B, et al.Burkitt leukemia presenting as acute appendicitis:a case report and literature review[J].Am J Case Rep, 2020, 21:e921568.DOI:10.12659/AJCR.921568.
[15] 李楠, 姚佳峰, 姜锦.儿童急性淋巴细胞白血病合并消化道穿孔五例临床分析[J].中国小儿急救医学, 2019, 26(10):785-789.DOI:10.3760/cma.j.issn.1673-4912.2019.10.014. Li N, Yao JF, Jiang J.Clinical analysis of 5 cases of childhood acute lymphoblastic leukemia with gastrointestinal perforation[J].Chin Pediatr Emerg Med, 2019, 26(10):785-789.DOI:10.3760/cma.j.issn.1673-4912.2019.10.014.
Memo
收稿日期:2024-12-12。
通讯作者:余克驰,Email:yukechicom@126.com