Gangrenous appendicitis in children: a different approach

Area of Science:

• Pediatric Surgery
• Infectious Diseases
• Wound Management

Background:

• Gangrenous appendicitis in children presents a significant risk of post-operative complications.
• Traditional management often involves drainage, which was omitted in this study.
• Intraperitoneal complications and wound infections are key concerns following appendectomy for complicated appendicitis.

Purpose of the Study:

• To evaluate the efficacy of appendectomy with saline irrigation and loose wound closure in pediatric patients with gangrenous appendicitis.
• To assess the impact of topical ampicillin powder application on reducing wound infection rates.
• To analyze the common bacterial pathogens and potential antibiotic synergism in this patient cohort.

Main Methods:

• A consecutive series of 50 children with gangrenous appendicitis underwent appendectomy, saline irrigation, and loose wound closure without drainage.
• Intravenous ampicillin and oxacillin were administered; ampicillin powder was applied topically to the wounds in 28 patients.
• Bacterial cultures were obtained, and antibiotic synergism was evaluated in a subset of patients.

Main Results:

• No intraperitoneal complications were observed in any of the 50 patients.
• Seven wound infections occurred, necessitating incision and drainage.
• Topical ampicillin powder application reduced the wound infection rate to less than 10%.

Conclusions:

• Appendectomy with saline irrigation and loose wound closure is a safe and effective approach for gangrenous appendicitis in children, avoiding intraperitoneal complications.
• Topical ampicillin powder is a valuable adjunct in preventing surgical site infections in this population.
• Escherichia coli, Streptococcus species, and anaerobic bacteria were the predominant organisms, with evidence of ampicillin-oxacillin synergism in some cases.