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Non-operative management of early, acute appendicitis in children: is it safe and effective?

Jeff Armstrong1, Neil Merritt2, Sarah Jones2

  • 1Division of General Surgery, Western University, London Health Sciences Centre, London, Ontario.

Journal of Pediatric Surgery
|May 24, 2014
PubMed

Insights

Early acute appendicitis in children can be safely managed with antibiotics alone. This approach shows comparable outcomes to surgery, with fewer complications and shorter hospital stays.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Emergency Medicine

Background:

  • Appendicitis is a common surgical emergency in children.
  • Traditional management involves surgical appendectomy.
  • Antibiotic-only management is being explored for early, acute appendicitis.

Purpose of the Study:

  • To evaluate the safety and efficacy of non-operative management (NOM) using antibiotics alone for early, acute appendicitis in children.
  • To compare outcomes of NOM with traditional operative management (OM).

Main Methods:

  • Retrospective review of children (<18 years) treated non-operatively (NOM) since May 2012.
  • Comparison with children treated with appendectomy (OM) between January 2011 and October 2011.
  • Inclusion criteria: symptoms <48 hours, localized peritonitis, ultrasound findings of early acute appendicitis.

Main Results:

  • Twelve children received NOM; 16.7% required subsequent appendectomy. One NOM patient had recurrent appendicitis.
  • Two OM patients (8.3%) experienced surgical site infections.
  • Mean length of stay was similar for both groups (1.8 days NOM vs. 1.7 days OM).

Conclusions:

  • Early acute appendicitis in carefully selected children can be treated successfully with antibiotics alone.
  • Further randomized trials with extended follow-up are needed to confirm these findings.
Abstract

Keywords:
AntibioticsAppendicitisNon-operative management

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