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Appendicitis in children
T C Putnam1, N Gagliano, R W Emmens
1Department of Surgery, University of Rochester, School of Medicine and Dentistry, New York.
Insights
Comparing appendicitis therapy from 1972-1987 in children, this study found that routine antibiotic use for perforated appendicitis maintained low complication and zero mortality rates. Peritoneal lavage technique may influence complications.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
Background:
- Appendicitis is a common pediatric surgical emergency.
- Previous studies established low complication and zero mortality rates for appendicitis treatment.
- Therapeutic advancements aim to further reduce morbidity and mortality.
Purpose of the Study:
- To evaluate if contemporary appendicitis treatment methods maintain low complication and zero mortality rates.
- To compare outcomes between two distinct pediatric appendicitis treatment periods (1972-1982 vs. 1982-1987).
- To identify potential factors influencing complication rates in pediatric appendicitis.
Main Methods:
- Retrospective comparison of 406 children treated for appendicitis (1982-1987) against 657 children (1972-1982).
- Analysis of complication rates (major and minor) and mortality.
- Assessment of therapeutic interventions including antibiotic coverage and peritoneal lavage.
Main Results:
- Routine antibiotic coverage for aerobic and anaerobic bacteria in perforated appendicitis yielded low complication rates: 3.2% major (e.g., obstruction, abscess) and 2.5% minor (e.g., wound infection, ileus).
- These complication rates were comparable to the earlier study period.
- The mortality rate remained zero in both study periods.
- Complete peritoneal lavage in cases of generalized or extensive localized peritonitis was associated with subsequent small intestinal obstruction in four patients, a complication not observed in patients without lavage.
Conclusions:
- Contemporary appendicitis therapy, including routine antibiotic use, effectively maintains low complication and zero mortality rates in children.
- The technique of peritoneal lavage, rather than the disease severity alone, may contribute to specific complications like small intestinal obstruction.
- Continued vigilance in surgical technique is crucial for optimizing outcomes in pediatric appendicitis management.
Abstract:
A study of 406 consecutive children operated upon for appendicitis from July 1982 to July 1987 was compared with a previously published study of 657 children with the same diagnosis operated upon between 1972 and 1982. This was done to determine if the methods of therapy continue to yield low complication rates and zero mortality rates. The routine use of antibiotic coverage for both aerobic and anaerobic bacteria in perforated appendicitis resulted in low complication rates, 3.2 per cent for major and 2.5 per cent for minor complications. Major complications included small intestinal obstruction and intra-abdominal abscess. Minor complications included wound infection and prolonged ileus. These rates are similar to those of the first investigation. The mortality rate continued to be zero. Complete peritoneal lavage was used in patients with generalized peritonitis or extensive localized peritonitis. Operative lysis of adhesions for small intestinal obstruction was required in four of these patients. This did not occur in patients with perforated appendicitis with abscess formation or more localized peritonitis who had no lavage. The technique rather than the disease process may be responsible for the complication.