WOFAPS 2025 8th World Congress of Pediatric Surgery

Eslem Nur Keleşoğlu, Beril dinçer, Zekeriya Tayyib Akbaş, Büşra Serbest, Secil Yuksel, Osman Hakan Kocaman, Başak Erginel

Istanbul University Istanbul Medical Faculty Department of Pediatric Surgery

Introduction

Abdominal pain is common in hematology-oncology patients due to malignancy or chemotherapy/radiotherapy. During neutropenia, serious conditions like appendicitis, typhlitis, lymphadenopathy, ischemia, and perforation must be considered. Immunosuppression leads to atypical clinical and imaging findings. When surgery is needed, resection should avoid necrotic tissue and be performed from healthy areas using safe techniques. This report presents a rare case of fungal necrotic appendicitis in a pediatric chemotherapy patient, managed with stapler-assisted laparoscopic appendectomy.

Case

An 11-year-old girl presented with shoulder pain and was diagnosed with hepatocellular neoplasia. Chemotherapy was initiated. On day 3 after the 6th cycle, she developed right lower quadrant pain. Imaging showed wall thickening in the cecum and terminal ileum. By day 5, ultrasound revealed a 6 mm appendix with surrounding edema. CRP was 365 mg/L. Due to worsening signs, diagnostic laparoscopy was performed. Exploration showed ecchymotic, poorly perfused areas in the appendix and cecum without perforation. As the appendiceal stump had poor vascularization, stapled excision was done at the appendiceal-cecal junction. A Douglas pouch drain was placed; no complications occurred.

Pathology revealed dense fungal structures consistent with Aspergillus. Though rare, fungal appendicitis should be considered in immunosuppressed patients. Literature reports an incidence of 1.15%, all in immunocompromised individuals. This case highlights the role of fungal infection in chemotherapy-related appendicitis and the safety of stapler use.

Conclusion

In necrotic appendiceal stump cases, especially with immunosuppression, resection should target healthy, perfused tissue. In this case, stapler-assisted laparoscopic appendectomy provided a safe, complication-free outcome. Fungal appendicitis, though rare, must be considered in immunosuppressed patients. This case emphasizes early diagnosis, careful planning, and appropriate technique in high-risk pediatric surgery.