# Conservative vs. surgical management of acute appendicitis in children with acute leukemia: a single-center retrospective case series

## TL;DR

This study examines how to manage acute appendicitis in children with leukemia, showing that conservative treatment or minimally invasive surgery can be effective based on individual cases.

## Contribution

The study provides practical evidence for individualized multidisciplinary treatment strategies in managing acute appendicitis in leukemic children.

## Key findings

- Conservative management successfully treated seven children with uncomplicated appendicitis.
- Three children with complicated appendicitis underwent minimally invasive laparoscopic surgery.
- All patients achieved infection control and resumed chemotherapy without mortality.

## Abstract

To explore the diagnostic challenges, individualized treatment strategies, and prognostic outcomes of acute appendicitis in children with acute leukemia and to provide practical evidence and clinical guidance for establishing a standardized multidisciplinary collaborative diagnosis and treatment protocol.

This single-center retrospective case series analyzed the clinical data of children with acute leukemia complicated by acute appendicitis admitted between December 2020 and December 2024. All children were evaluated by a multidisciplinary team (MDT). Individualized treatment plans, including either conservative management or surgical appendectomy, were formulated based on MDT assessment. Clinical data were analyzed retrospectively to summarize diagnostic and therapeutic experience.

Among the 10 children in this study, appendicitis onset occurred during induction (n = 5), consolidation (n = 2), or maintenance (n = 3) chemotherapy. Seven children with uncomplicated appendicitis were successfully treated conservatively with anti-infective and hematopoietic support. The remaining three children, presenting with fecalith impaction or perforation, underwent emergency transumbilical single-site double-port laparoscopic appendectomy (TSSDPLA); pathology confirmed suppurative or gangrenous appendicitis.

This small case series highlights that managing acute appendicitis in leukemic children requires individualized MDT-guided strategies. Conservative treatment was effective for uncomplicated cases, while TSSDPLA provided a feasible minimally invasive option for complications. Early resumption of chemotherapy was prioritized. All patients achieved infection control and continued leukemia therapy without mortality. These findings offer a preliminary management framework, pending validation in larger studies.