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Unexpected findings after surgery for suspected appendicitis rarely change treatment in pediatric patients; Results
Ramon R Gorter1, Paul van Amstel2, Johanna H van der Lee3
1Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, P.O. Box 22660, 1100DD Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Vondellaan 13 1942 LE, Beverwijk, The Netherlands.
Insights
Non-operative treatment is safe for children with acute simple appendicitis. Unexpected findings during appendectomy are rare (2.1%) and rarely alter treatment plans, supporting conservative management.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Pathology
Background:
- Acute appendicitis is common in children.
- Appendectomy is the standard treatment.
- The safety of non-operative management requires evaluation of unexpected findings.
Purpose of the Study:
- To assess the incidence of unexpected findings in children undergoing appendectomy for suspected acute appendicitis.
- To evaluate the impact of these findings on subsequent treatment plans.
Main Methods:
- Retrospective cohort study (Level 2 evidence) from January 2004 to December 2014.
- Included 484 children (0-17 years) undergoing appendectomy for suspected acute appendicitis.
- Reviewed intra-operative and histopathological findings, and subsequent treatment changes.
Main Results:
- Unexpected findings occurred in 10 (2.1%) patients.
- Two intra-operative findings (Ileitis terminalis, ovarian torsion).
- Eight post-histopathology findings (parasitic infections, Walthard cell rest, carcinoid, endometriosis).
- Treatment was altered in only 4 (<1%) patients.
Conclusions:
- The low incidence of unexpected findings supports the safety of a non-operative strategy for acute simple appendicitis.
- Extremely few treatment changes were necessitated by serious unexpected findings.
Background:
To determine if non-operative treatment is safe in children with acute appendicitis, we evaluated the incidence of unexpected findings after an appendectomy in children, and the influence they have on subsequent treatment.
Methods:
A historical cohort study (January 2004-December 2014) was performed including children, aged 0-17 years, who underwent an appendectomy for the suspicion of acute appendicitis. Patients were divided based upon histopathological examination. Unexpected findings were reviewed, as well as the subsequent treatment plan.
Results:
In total 484 patients were included in this study. In the overall group, unexpected findings were noted in 10 (2.1%) patients of which two patients intra-operatively with a non-inflamed appendix (Ileitis terminalis N=1 and ovarian torsion N=1) and in 8 patients on histopathological examination. The latter group consisted of 4 patients with concomitant simple appendicitis (parasitic infection N=3 and Walthard cell rest N=1), two with concomitant complex appendicitis (carcinoid N=1 and parasitic infection N=1) and two patients with a non-inflamed appendix (endometriosis N=1 and parasitic infection N=1). Treatment was changed in 4 patients (<1%).
Conclusions:
Results from this study corroborate the safety of non-operative strategy for acute simple appendicitis, as the occurrence of unexpected findings was low, with extremely few necessary changes of the treatment plan because of serious findings.
Type Of Study:
Prognosis study.
Level Of Evidence:
Level 2 (retrospective cohort study).
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