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Risk factors for the development of abdominal abscess following operation for perforated appendicitis in children: a

Marion C W Henry1, Angela Walker, Bonnie L Silverman

  • 1Yale University School of Medicine, New Haven, CT 06520, USA.

Archives of Surgery (Chicago, Ill. : 1960)
|March 21, 2007
PubMed

Insights

Intraoperative fecaliths and diarrhea at presentation are key risk factors for intra-abdominal abscesses after perforated appendicitis in children. Children who are fever-free and eating by postoperative day 3 can be safely discharged with a low risk of abscess.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Infectious Disease

Background:

  • Perforated appendicitis in children leads to significant morbidity, including intra-abdominal abscesses.
  • Intra-abdominal abscesses necessitate prolonged hospitalization, extensive antibiotic use, and invasive procedures.

Purpose of the Study:

  • To identify risk factors associated with the development of intra-abdominal abscesses following treatment for perforated appendicitis in children.

Main Methods:

  • A case-control study was conducted across four tertiary care children's hospitals.
  • Data from 265 children (aged 1-18 years) with appendicitis were analyzed using multivariable logistic regression.
  • Outcomes included postoperative abscess development, hospital stay, fever, and diet tolerance on postoperative day 3.

Main Results:

  • An intraoperative fecalith (OR, 8.77) and diarrhea at presentation were significant predictors of abscess development.
  • Commonly suspected factors like pain history, antibiotic timing, and operative findings were not significant predictors.
  • Children discharged on or before postoperative day 3 had no abscesses, while 2 remaining children developed abscesses (P = .06).

Conclusions:

  • Traditional predictors of abscess formation after perforated appendicitis are unreliable.
  • Discharging children who are afebrile and tolerating a diet by postoperative day 3 is associated with a low rate of abscess development.
Abstract

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