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Management of perforated appendicitis in children. The controversy continues
Insights
This study presents a successful treatment protocol for perforated appendicitis in children, significantly reducing complications and infections. The intensive therapy approach ensures better patient outcomes with no reported deaths.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
Background:
- Perforated appendicitis in children presents significant management challenges.
- Existing treatment protocols may lead to substantial morbidity.
Purpose of the Study:
- To evaluate the efficacy of a specific intensive treatment protocol for perforated appendicitis in pediatric patients.
- To assess the complication and infection rates associated with this protocol.
Main Methods:
- A protocol involving appendectomy, systemic antibiotics (gentamicin, ampicillin, clindamycin), peritoneal irrigation, and transperitoneal drainage was applied to 143 children.
- Data on patient demographics, hospitalization, and complications were collected and analyzed.
Main Results:
- The protocol was applied to 143 pediatric patients with an average age of 9.1 years.
- Only 7.7% of patients experienced significant complications, with 4.2% suffering infection-related issues.
- The average hospitalization stay was 12.1 days, and no deaths occurred.
Conclusions:
- This intensive primary therapy protocol significantly decreases sequelae from perforated appendicitis in children.
- The established protocol demonstrates a high safety and efficacy profile for managing perforated appendicitis in pediatric populations.
Abstract:
A specific treatment plan for management of perforated appendix in children, initiated at the Children's Hospitals in Boston, and later utilized at the Child Health Center in Galveston, has been applied to 143 patients by many surgical housestaff and faculty. The protocol consists of appendectomy, routine use of systemic gentamicin, ampicillin and clindamycin, antibiotic peritoneal irrigation, and transperitoneal drainage through the incision. The average age of the children in this series was 9.1 years (range 14 months to 21 years). The average length of hospitalization was 12.1 days. The use of this protocol resulted in only 11 patients (7.7%) developing significant complications. Complications related to infection occurred in only six of the eleven patients (4.2%). There were no deaths. This protocol of intensive primary therapy can significantly decrease the sequelae from perforated appendicitis in children.