Right Lower Quadrant Pain in Patients with Acute Myeloid Leukemia

Kang, Won Kyung; Kim, Sang Dong; Kim, Hyung Jin; Cho, Hyun Min; Park, Seung Chul; Jeon, Hae Myung; Oh, Se Jeong; Oh, Seong Taek

Abstract

PURPOSE
Acute appendicitis and typhlitis are difficult problems in acute myeloid leukemia (AML) patients. Whereas the treatment of typhlitis is primarily conservative, acute appendicitis is managed by surgery. The difficulty lies in distinguishing between the two becauae they both present similar conditions, and before surgery or autopsy, differentiation of these disease is nearly impossible. Careful evaluation is necessary before considering surgical treatment. In order to determinate proper treatment, we have reviewed our experiences with the right lower quadrant (RLQ) abdominal pain in patients with AML. METHODS: From July 1990 to December 2001, at St. Mary's hospital, Seoul, Korea, the records of AML patients that were consulted to the surgical department for RLQ abdominal pain were reviewed. Thirty patients were consulted and 12 out of the 30 patients underwent surgery. RESULTS: The average age of the patients who underwent operation was 33.9, with 9 males and 3 females. Six patients were in complete remission, and the other 6 were in the active state. RLQ pain was the first symptom of AML in four patients. All 12 patients had RLQ pain and 10 had rebound tenderness. In three patients, the white blood cell (WBC) count was less than 1, 000/mm3. Appendectomy was performed in five patients, appendectomy with drainage was performed in five, and laparoscopic appendectomy was performed in two patients. The final diagnosis was periappendicial abscess in four cases, leukemic cell infiltration in three cases, adenocarcinoma in one case, and typhlitis in three patients. Four patients developed wound infection and one patient died due to sepsis 7 days after the operation. For the patients who were treated medically, the average age was 36, with 11 males and 7 females. Seven patients were in the active state, three patients were in CR, four patients were in the refractory state, and two patients were in relapse. Six patients died within one month because of sepsis or pneumonia. CONCLUSION: Surgery is safe and is the sole method that can improve the survival rate in patients with AML and RLQ abdominal pain. Furthermore, complications related to surgery may be reduced through the laparoscopic surgery.