Acute abdominal conditions such as tiflitis, acute appendicitis and intussusception can be found in the follow-up of children with leukemia. Its considered if one or more of the symptoms of abdominal pain, vomiting, fever, distention in the abdominal examination, sensitivity, tenderness and defenses are available together and the diagnosis is supported by radiological imaging methods. In these patients, making a surgical decision is not as easy as those with a strong immune system due to the increased risk of complications and death. Antimicrobial therapy, blood indrigents and electrolyte support are vital. In this study, we examined our patients with leukemia diagnosed with acute surgical abdomen in terms of clinical findings, prognosis and treatments, and we aimed to show that the results were satisfactory with good management in these patients.

Totally 9 patients who underwent surgery due to acute abdomen when all were ın follow up in our hospital's Pediatric Hematology-Oncology Clinic between July 2016 and December 2020 were examined retrospectively. The patients were under treatment according to the Berlin-Frankfurt-Munich protocol risk groups. The diagnosis of acute abdomen was made with clinical, laboratory and radiological findings. Abdominal direct X-ray graphy view of 2 years old unpefore tiflitis patient displayed in Figure1. The criterion for appendicitis was accepted as measuring the diameter of the appendix > 6mm in thickness, 3 mm thickness of cecum or terminal ileum for ultrasonography (USG) or Computed Tomography (CT). Abdominal computed tomography of 11 years old unpefore tiflitis patient displayed in Figure 2. Demographic information, diagnosis, clinical and laboratory findings, radiological examinations, treatments and results of the patients were recorded. (Table 1)

Seventh of the patients were diagnosed as ALL, two were AML, two were operated due to perforated tiflitis, five were acute appendicitis, one was operated due to intussusception, and  five were girls and four were males. All patients received broad-spectrum antibiotic therapy and four received additional antifungal therapy. Liquid electrolyte disturbance was observed and recovered in two patients. While blood product transfusions were applied to all patients, one patient was given additional granulocytes and pentaglobulin. A second operation was required due to the delayed wound healing in one patient. Apart from this, no complications were seen. Chemotherapy regimens were continued. (Table 2)

Acute appendicitis has been reported with a frequency of 0.5-4.4%, tiflit 2.6-10% in different studies in pediatric patients with hematologic cancer. The diagnosis of acute abdomen should be rapidly considered and supported by imaging methods. Although the complications and mortality rates of surgery in these patients are higher than the immune system intact patients, early diagnosis, broad-spectrum antibiotics, antifungal use, appropriate liquid electrolyte and blood product support can be performed successfully.