A plea for incidental appendectomy in pediatric patients with malignancy

The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric pa tients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure aft er operation for perforated appendicitis without generalized peritonitis. T he second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignan t pelvic spread, underwent an unnecessary abdominal exploration for suspect ed AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been p erformed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.