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Is delayed operative treatment worth the trouble with perforated appendicitis is children?

Thomas R Weber1, Martin A Keller, Richard J Bower

  • 1Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, and Cardinal Glennon Children's Hospital, St. Louis, MO 63104, USA. Weberm2@slu.edu

American Journal of Surgery
|December 16, 2003
PubMed

Insights

Initial antibiotic treatment for perforated appendicitis in children can be effective for select cases. This approach, followed by delayed surgery, may reduce complications compared to immediate appendectomy.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Infectious Disease Management

Background:

  • Perforated appendicitis in children is common, with 30-50% presenting with perforation.
  • Optimal management strategies for perforated appendicitis in pediatric patients remain a subject of debate.

Purpose of the Study:

  • To evaluate the efficacy of initial non-operative management with antibiotics and abscess drainage for perforated appendicitis in children.
  • To compare outcomes of immediate appendectomy versus non-operative management followed by interval appendectomy.

Main Methods:

  • A study involving 96 children (2-16 years) with perforated appendicitis.
  • Group I (n=71): immediate appendectomy with abscess drainage.
  • Group II (n=16): initial non-operative management with antibiotics and drainage, followed by interval appendectomy.
  • Group III (n=9): initial non-operative management failure, followed by early appendectomy.

Main Results:

  • Readmission rates were significantly lower in non-operative groups (12.5% and 11%) compared to immediate appendectomy (28%).
  • Complications included wound infection, pelvic abscess, and pancreatitis, observed more frequently in the immediate appendectomy group.
  • While length of stay and white blood cell (WBC) count at presentation were similar, the fall in WBC on day 4 was notable in the successful non-operative group.

Conclusions:

  • Initial antibiotic treatment and delayed appendectomy can be a successful strategy for select pediatric patients with perforated appendicitis.
  • This approach is particularly beneficial for children with minimal peritonitis, mild fever, and a significant WBC count decrease within 3-4 days.
  • Non-operative management may reduce the incidence of surgical site infections and other complications associated with immediate appendectomy.
Abstract

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