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Acute appendicitis in children: not only surgical treatment

Anna Maria Caruso1, Alessandro Pane1, Roberto Garau1

  • 1Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy.

Journal of Pediatric Surgery
|September 11, 2016
PubMed

Insights

Conservative management for uncomplicated appendicitis in children shows a 58% success rate. This approach, alongside early surgery for complicated cases, proves effective in guiding treatment decisions for pediatric appendicitis.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Disorders
  • Medical Diagnostics

Background:

  • Accurate diagnosis of acute appendicitis is crucial to prevent severe outcomes and avoid unnecessary surgical interventions.
  • Management strategies for pediatric appendicitis remain a subject of debate, necessitating evaluation of different treatment protocols.
  • Distinguishing between uncomplicated and complicated appendicitis is key for appropriate therapeutic decision-making in children.

Purpose of the Study:

  • To assess the efficacy of conservative management for uncomplicated appendicitis in both younger and older children.
  • To evaluate the outcomes of complicated appendicitis cases that undergo early surgical intervention.
  • To determine the effectiveness of a clinical protocol in differentiating surgical and conservative treatment candidates.

Main Methods:

  • A study involving 362 pediatric patients diagnosed with acute appendicitis.
  • Patients were evaluated using clinical, laboratory, and abdominal ultrasound findings, categorized into complicated and uncomplicated groups.
  • Uncomplicated cases initiated conservative antibiotic treatment, with surgery reserved for non-responders within 24-48 hours; complicated cases underwent immediate surgery.

Main Results:

  • Out of 362 patients, 165 underwent immediate surgery, while 197 were initially treated conservatively, with 82 requiring delayed surgery due to treatment failure.
  • The overall surgical intervention rate was 68.2%.
  • A significant correlation was observed between diagnostic ultrasound findings and the decision for surgical intervention.

Conclusions:

  • Conservative management achieved a high success rate (58%) for uncomplicated pediatric appendicitis.
  • Complications were infrequent among patients who underwent surgery.
  • The established protocol effectively guided treatment choices, with specific indicators like age and symptom onset identifying high-risk patients for complications or conservative treatment failure.
Abstract

Keywords:
Abdominal ultrasoundAcute appendicitisAppendicular massConservative treatmentEarly appendectomySurgery complications

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