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Early decisions in perforated appendicitis in children: lessons from a study of nonoperative management

Christine Whyte1, Terry Levin, Burton H Harris

  • 1Division of Pediatric Surgery, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY 10467, USA. cwhyte@montefiore.org <cwhyte@montefiore.org>

Journal of Pediatric Surgery
|August 5, 2008
PubMed

Insights

Early identification of treatment failure in perforated appendicitis is crucial. Fever persistence, bandemia, and CT findings can predict nonoperative management failure, guiding timely surgical decisions.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Emergency Medicine

Background:

  • Nonoperative management is an option for perforated appendicitis in children.
  • Some children do not respond to nonoperative treatment, necessitating surgical intervention.
  • Early identification of treatment failure is essential for optimal surgical decision-making.

Purpose of the Study:

  • To identify early indicators of treatment failure in children with perforated appendicitis managed nonoperatively.
  • To aid in surgical decision-making for cases of perforated appendicitis.

Main Methods:

  • A cohort of 58 children with computed tomographic (CT)-proven perforated appendicitis were treated nonoperatively.
  • Treatment success was defined as recovery, while failure was indicated by the need for appendectomy.
  • Key parameters including white blood cell differential (band forms), temperature response at 24 hours, and CT scan abdominal involvement were analyzed.

Main Results:

  • 62% (36/58) of patients responded to nonoperative treatment; 38% (22/58) failed.
  • Admission bandemia, persistent fever after 24 hours, and multisector abdominal involvement on CT scan distinguished treatment failures.
  • Patients failing nonoperative management experienced longer hospital stays (17 vs. 9 days) and higher complication rates (46% vs. 0%).

Conclusions:

  • Failure of nonoperative management for perforated appendicitis is linked to increased complications.
  • Persistent fever after 24 hours, admission bandemia, and multisector CT findings are key indicators of nonoperative treatment failure.
  • These indicators, combined with clinical judgment, facilitate early decisions regarding appendectomy.
Abstract

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