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Pediatric appendicitis. A 20-year study of 1,640 children at Cook County (Illinois) Hospital
Insights
Delayed wound closure significantly reduced wound infections in children with appendicitis and perforation. However, antibiotics and transperitoneal drainage did not impact intra-abdominal abscess rates.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
Background:
- Acute appendicitis is a common surgical emergency in children.
- Appendiceal perforation complicates a significant percentage of pediatric appendicitis cases, increasing morbidity.
Purpose of the Study:
- To evaluate the impact of specific interventions on outcomes in children with perforated appendicitis.
- To assess the effectiveness of antibiotics, transperitoneal drainage, and delayed wound closure.
Main Methods:
- Retrospective analysis of 1,640 pediatric appendicitis cases from 1957-1976.
- Comparison of outcomes (morbidity, mortality, abscess formation, wound infection) based on treatment protocols.
Main Results:
- 35% of children presented with appendiceal perforation.
- Delayed wound closure reduced wound infection incidence by 75%.
- Antibiotics and transperitoneal drainage showed no significant effect on intra-abdominal abscess formation.
Conclusions:
- Delayed wound closure is a crucial strategy for reducing surgical site infections in perforated appendicitis.
- Routine use of antibiotics and transperitoneal drainage may not be effective in preventing intra-abdominal abscesses in this population.
Abstract:
Of 1,640 children with acute appendicitis treated at Cook County (Illinois) Hospital between Jan 1, 1957, and Dec 31, 1976, 35% had appendiceal perforation. Overall morbidity was 12.8% and mortality was 0.24%. Antibiotics, transperitoneal drainage, and delayed wound closure were used routinely in children with appendiceal perforation. Antibiotics and transperitoneal drains did not appreciably alter the incidence of intraabdominal abscess formation. Delayed wound closure in patients with appendiceal perforation reduced the incidence of wound infection by 75%.