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Perforation risk in pediatric appendicitis: assessment and management
Erin C Howell1, Emily D Dubina1, Steven L Lee1,2
1Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA, stevenlee@mednet.ucla.edu.
Pediatric Health, Medicine and Therapeutics
|November 23, 2018
Summary
Perforated appendicitis in children is difficult to diagnose and treat. This review discusses diagnostic tools and treatment options for perforated appendicitis, aiming to guide clinical decisions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Perforated appendicitis in children presents diagnostic challenges.
- It is associated with significant morbidity in the pediatric population.
- Younger patients and prolonged symptoms increase perforation risk.
Purpose of the Study:
- To review diagnostic tools for perforated appendicitis.
- To discuss current treatment strategies and their controversies.
- To propose an algorithm for guiding treatment decisions.
Main Methods:
- Review of diagnostic modalities including ultrasound and CT scans.
- Analysis of laboratory markers such as leukocytosis and C-reactive protein.
- Evaluation of treatment options: non-operative management versus early appendectomy.
Main Results:
- No single symptom or sign accurately predicts perforated appendicitis.
- Leukocytosis, bandemia, elevated CRP, hyponatremia, ultrasound, and CT aid diagnosis.
- Factors predicting non-operative failure include appendicolith, high WBC count, and CT findings.
Conclusions:
- Accurate diagnosis of perforated appendicitis is crucial for appropriate management.
- Treatment remains controversial, with non-operative and operative approaches.
- An evidence-based algorithm can help guide individualized treatment strategies.
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