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Gangrenous appendicitis in children: a different approach
Insights
This study on pediatric gangrenous appendicitis found that dusting ampicillin powder into wounds significantly reduced surgical site infections. This simple intervention improved outcomes for children undergoing appendectomy.
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.
Abstract:
Fifty children with gangrenous appendicitis were treated consecutively by appendectomy followed by saline irrigation and loose wound closure. Drainage was not employed. Ampicillin and oxacillin were mixed and given intravenously. In 28 of 50 patients, ampicillin powder was dusted into the wound. No intraperitoneal complications occurred. Seven would infections required incision. Dusting ampicillin powder into the wound reduced this complication to less than 10 per cent. Four patients had nasogastric tubes. The usual hospital stay was three to eight days. The most common organisms cultured were Escherichia coli (68%), Streptococcus species (60%), and anaerobic species (48%). Eleven patients were evaluated for synergism between ampicillin and oxacillin. Eight showed some evidence of synergism in that the minimal inhibitory concentration (MIC) of the combination was less than the MIC of the individual drugs.