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Background <p>Acute abdomen in immunocompromised pediatric oncology patients presents significant diagnostic and therapeutic challenges due to atypical clinical presentations and the complexity of their underlying conditions. Conventional diagnostic methods, including clinical assessment and imaging, often fail to provide conclusive results, resulting in delays in diagnosis and treatment. Early diagnostic laparoscopy offers the advantage of both diagnosis and therapy in a minimally invasive manner, which may improve outcomes for this patient population.</p> Methods <p>A prospective cohort study was conducted involving 21 pediatric oncology patients, aged 1 day to 18 years, who presented with acute abdominal symptoms at a tertiary care training and research hospital between January 2022 and December 2023. Participants underwent preoperative imaging, with diagnostic laparoscopy performed in cases where imaging results were inconclusive. A comprehensive dataset, including demographic information, clinical presentations, imaging findings, laparoscopic findings, therapeutic interventions, and postoperative outcomes, was systematically collected and analyzed.</p> Results <p>Diagnostic laparoscopy revealed pathological findings in 76.2% of cases, with appendicitis constituting the predominant diagnosis at 47.6%.</p> <p>Postoperatively, 76.2% of patients exhibited significant clinical improvement, including resolution of abdominal symptoms and the resumption of chemotherapy. Early intervention was significantly associated with enhanced clinical outcomes, evidenced by a quicker recovery and an expedited return to chemotherapy (<i>p</i> = 0.035). Notably, conversion to an open surgical approach occurred in 38.1% of instances, largely attributable to extensive adhesions or complex underlying pathologies.</p> Conclusion <p>Early diagnostic laparoscopy serves as a critical intervention for acute abdominal conditions in immunocompromised pediatric oncology patients. This minimally invasive technique significantly enhances diagnostic precision, allows for prompt therapeutic measures, and fosters improved postoperative recovery. Given the unique vulnerabilities of this patient demographic, laparoscopy may be considered earlier in cases where imaging is inconclusive and conservative management fails.</p>

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The role of early diagnostic laparoscopy in acute abdomen in immunocompromised pediatric oncology patients: a prospective study

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Ahmed Oshiba,
  • Ossama Kasem,
  • Ahmed Khairi,
  • Ahmed Elrouby

摘要

Background

Acute abdomen in immunocompromised pediatric oncology patients presents significant diagnostic and therapeutic challenges due to atypical clinical presentations and the complexity of their underlying conditions. Conventional diagnostic methods, including clinical assessment and imaging, often fail to provide conclusive results, resulting in delays in diagnosis and treatment. Early diagnostic laparoscopy offers the advantage of both diagnosis and therapy in a minimally invasive manner, which may improve outcomes for this patient population.

Methods

A prospective cohort study was conducted involving 21 pediatric oncology patients, aged 1 day to 18 years, who presented with acute abdominal symptoms at a tertiary care training and research hospital between January 2022 and December 2023. Participants underwent preoperative imaging, with diagnostic laparoscopy performed in cases where imaging results were inconclusive. A comprehensive dataset, including demographic information, clinical presentations, imaging findings, laparoscopic findings, therapeutic interventions, and postoperative outcomes, was systematically collected and analyzed.

Results

Diagnostic laparoscopy revealed pathological findings in 76.2% of cases, with appendicitis constituting the predominant diagnosis at 47.6%.

Postoperatively, 76.2% of patients exhibited significant clinical improvement, including resolution of abdominal symptoms and the resumption of chemotherapy. Early intervention was significantly associated with enhanced clinical outcomes, evidenced by a quicker recovery and an expedited return to chemotherapy (p = 0.035). Notably, conversion to an open surgical approach occurred in 38.1% of instances, largely attributable to extensive adhesions or complex underlying pathologies.

Conclusion

Early diagnostic laparoscopy serves as a critical intervention for acute abdominal conditions in immunocompromised pediatric oncology patients. This minimally invasive technique significantly enhances diagnostic precision, allows for prompt therapeutic measures, and fosters improved postoperative recovery. Given the unique vulnerabilities of this patient demographic, laparoscopy may be considered earlier in cases where imaging is inconclusive and conservative management fails.