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Interval appendectomy for perforated appendicitis in children
1Section of Pediatric Surgery, University of Tennessee, Le Bonheur Children's Medical Center, Memphis 38105, USA.
Insights
Managing perforated appendicitis with intravenous antibiotics and interval appendectomy is safe and effective. This approach reduces hospitalization, costs, and morbidity compared to immediate surgery, with bowel obstruction indicating prompt appendectomy.
Area of Science:
- Pediatric Surgery
- Infectious Disease Management
- Gastrointestinal Health
Background:
- Perforated appendicitis presents significant management challenges in children.
- Traditional management often involves immediate appendectomy, potentially increasing risks and costs.
Purpose of the Study:
- To evaluate the efficacy, safety, and cost-effectiveness of treating perforated appendicitis with intravenous antibiotics followed by interval appendectomy.
- To identify criteria for proceeding with immediate appendectomy.
Main Methods:
- Retrospective chart review of 87 children with ruptured appendicitis.
- Comparison of outcomes between immediate appendectomy (n=46) and interval appendectomy (n=41) after antibiotic treatment.
- Analysis of antibiotic regimens (clindamycin and ceftazidime) and discontinuation criteria.
Main Results:
- The interval appendectomy protocol was successful in 83% of cases (7 patients failed).
- Bowel obstruction (developing or persisting >72 hours) was the primary reason for protocol failure.
- Successful interval appendectomy was associated with reduced hospitalization, charges, and morbidity.
Conclusions:
- Intravenous antibiotics followed by interval appendectomy offer a safe and effective alternative for managing perforated appendicitis in children.
- Persistent bowel obstruction exceeding 72 hours is a key indicator for immediate appendectomy.
- This conservative approach can lead to better patient outcomes and resource utilization.
Abstract:
To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.