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Conservative management of appendix mass in children
J Gillick1, M Velayudham, P Puri
1The Chidren's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Conservative management of pediatric appendix masses is effective. Non-operative treatment followed by elective appendectomy offers a safe and successful approach for children, reducing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Management of pediatric appendix masses remains a subject of debate.
- This study reviews a 19-year experience with conservative management of appendix masses in children.
Purpose of the Study:
- To evaluate the safety and efficacy of non-operative management of appendix masses in a pediatric population.
- To assess outcomes of conservative treatment followed by interval appendectomy.
Main Methods:
- Retrospective review of medical records for children with appendix masses (1982-2000).
- Comparison of immediate appendectomy versus conservative management (observation, antibiotics, supportive care).
- Analysis of complication rates and hospital stay for elective appendectomy.
Main Results:
- 84.2% of children (346/411) responded to initial conservative management.
- Elective appendectomy after conservative treatment had a low complication rate (2.3%).
- Histological confirmation of inflammation in 50.8% of removed appendices.
Conclusions:
- Non-operative management of pediatric appendix masses is a safe and effective strategy.
- Conservative management followed by elective appendectomy leads to favorable outcomes.
Background:
The management of an appendix mass in children is controversial. An experience of conservative management of appendix masses in a paediatric population over the last 19 years is reviewed.
Methods:
The medical records of all children who presented with an appendix mass to one of three children's hospitals between 1982 and 2000 were reviewed. In that interval 427 children with a mean age of 7.3 years (range from 2 months to 18 years) presented with an appendix mass. Sixteen children had an immediate appendicectomy. The remaining 411 children were treated conservatively by close observation and antibiotics, with intravenous fluids and nasogastric suction if required. Once the child was well enough for discharge home, elective appendicectomy was booked for 4-6 weeks later.
Results:
Three hundred and forty-six (84.2 per cent) of the children responded to initial conservative management and were discharged after a median stay of 6 (range 3-24) days. The children returned 4-6 weeks later for elective appendicectomy. The complication rate for elective appendicectomy was 2.3 per cent (eight patients). Those who had an uncomplicated elective appendicectomy had a median hospital stay of 3 (range 1-6) days. Histological examination demonstrated acute or subacute inflammation in 50.8 per cent of appendices removed at elective appendicectomy.
Conclusion:
Non-operative management of an appendix mass followed by elective appendicectomy is a safe and effective method of management.