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Nonsurgical management of appendiceal mass in late presenting children
Insights
Nonoperative management of appendiceal mass in children, using intravenous fluids and alimentation without antibiotics, is safe and effective. Diligent observation is key, with interval appendectomy recommended for all patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Appendiceal mass in children often presents late, posing treatment challenges.
- Traditional management has varied, with evolving approaches to nonoperative care.
Purpose of the Study:
- To evaluate the safety and efficacy of nonoperative management for pediatric appendiceal mass.
- To assess outcomes including clinical improvement, recurrence, and pathological findings after interval appendectomy.
Main Methods:
- Retrospective review of 37 children with appendiceal mass treated between 1965-1975.
- Treatment involved intravenous fluids, alimentation, and observation without antibiotics.
- All patients underwent interval appendectomy after initial management.
Main Results:
- 81% of children showed clinical improvement within a mean of 10.9 days.
- 19% required abscess drainage due to recurrence or worsening symptoms.
- No mortality or antibiotic use was recorded; interval appendectomy specimens showed significant inflammation.
Conclusions:
- Nonoperative management of pediatric appendiceal mass without antibiotics is a safe approach with close monitoring.
- Interval appendectomy is feasible even after delayed resolution or drainage, with pathological findings indicating persistent inflammation.
Abstract:
Thirty-seven late presenting children with appendiceal mass were treated between 1965 and 1975 with i.v. fluids, alimentation according to the state of gastrointestinal function, and no antibiotics. They ranged in age from 18 mo to 16 yr and all had had symptoms for at least 5 days (mean 8.7), an abnormal WBC (mean 19.9), and a fixed palpable mass without rebound tenderness. Children were discharged when clinical findings resolved. All returned for interval appendectomy. Eighty-one percent (31 children) had clinical improvement within 5-22 days (mean 10.9). Nineteen percent (7 children) had recurrence or worsening of symptoms and required abscess drainage within 2-10 days after observation began. No child in either group received antibiotics nor did any die. Only one recurrence of symptoms after discharge was recorded before interval appendectomy. Pathologic specimens revealed fibrosis in 46%, subacute inflammation in 35%, and acute inflammation in 19%. Nonoperative management of the appendiceal mass without antibiotics in children is safe as long as diligent observation is maintained. Interval appendectomy can be performed as late as 20 wk after symptom resolution or drainage, however, over 50% of the interval appendectomy specimens reveal acute and subacute inflammation.