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Nonoperative management of appendiceal phlegmon or abscess with an appendicolith in children

Hai-Lan Zhang1, Yu-Zuo Bai, Xin Zhou

  • 1Department of Pediatric Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao St, Heping District, Shenyang, China, 110004.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|January 15, 2013
PubMed

Insights

Nonoperative management is effective for pediatric appendiceal phlegmon or abscess with appendicolith, with most stones resolving. Persistent appendicoliths increase recurrent appendicitis risk, warranting interval appendectomy.

Area of Science:

  • Pediatric surgery
  • Gastroenterology

Background:

  • Optimal treatment for appendiceal phlegmon or abscess with an appendicolith in children remains debated.
  • Nonoperative management (NOM) is an alternative to surgery for these conditions.

Purpose of the Study:

  • To evaluate the outcomes and prognosis of nonoperative management for pediatric appendiceal phlegmon or abscess with an appendicolith.
  • To compare outcomes based on the presence or absence of an appendicolith and its resolution during follow-up.

Main Methods:

  • Retrospective review of 105 children treated nonoperatively from 2007-2011.
  • Analysis of data comparing outcomes between children with and without appendicoliths.
  • Assessment of appendicolith disappearance and its association with recurrence.

Main Results:

  • Successful nonoperative therapy for appendiceal phlegmon or abscess with appendicolith was 95.9%.
  • Recurrent appendicitis risk was higher in patients with appendicoliths (19.1%) compared to those without (8.9%).
  • Persistent appendicoliths were linked to a significantly higher recurrence rate (66.7%) versus appendicolith disappearance (7.9%).

Conclusions:

  • Nonoperative management is a viable option for pediatric appendiceal phlegmon or abscess with appendicolith.
  • Most appendicoliths resolve during nonoperative management.
  • Persistent appendicoliths are a significant risk factor for recurrent appendicitis, suggesting a potential role for interval appendectomy in such cases.
Abstract

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