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Perforated appendicitis: past and future controversies
1Department of Surgery, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey 17033, USA.
Insights
Pediatric perforated appendicitis remains common despite surgical advances. This review covers current management controversies and future treatment options like laparoscopy and outpatient antibiotics.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Public Health
Background:
- Pediatric appendicitis mortality is near zero due to surgical and antibiotic advancements.
- The incidence of perforated appendicitis in children remains high.
- Current management strategies for perforated appendicitis require review.
Purpose of the Study:
- To review recent literature on perforated pediatric appendicitis.
- To discuss controversies in managing ruptured appendix in children.
- To consider future evaluation and treatment trends.
Main Methods:
- Literature review of perforated pediatric appendicitis.
- Discussion of surgical and medical management controversies.
- Analysis of emerging treatment modalities and referral pattern changes.
Main Results:
- Mortality rates for pediatric appendicitis are very low.
- Perforated appendicitis incidence in children remains a significant concern.
- Laparoscopy and outpatient antibiotic therapy are potential future options.
Conclusions:
- Despite low mortality, perforated appendicitis in children warrants continued research.
- Future management may involve less invasive techniques and altered care pathways.
- Managed care enrollment may impact referral patterns for pediatric appendicitis.
Abstract:
Although mortality rates for pediatric appendicitis have been reduced to near zero with the development of safe surgical procedures and routine perioperative antibiotic therapy, the incidence of perforated appendicitis in children has remained at a comparatively high level. This article reviews the recent literature on perforated pediatric appendicitis, including a discussion of some of the controversies concerning management of the ruptured appendix. In addition, the future of both the evaluation and treatment of this disease, including laparoscopy, the possibilities for outpatient antibiotic therapy, and the worrisome potential for a change in referral patterns as children with this disease are increasingly enrolled in managed care plans, are considered.