Acute appendicitis in children: not only surgical treatment

Abstract Purpose An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the ou...

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Bibliographic Details
Published in:Journal of pediatric surgery 2017-03, Vol.52 (3), p.444-448
Main Authors: Caruso, Anna Maria, Pane, Alessandro, Garau, Roberto, Atzori, Pietro, Podda, Marcello, Casuccio, Alessandra, Mascia, Luigi
Format: Article
Language:English
Subjects:
Abdominal ultrasound
Acute appendicitis
Acute Disease
Adolescent
Anti-Bacterial Agents - therapeutic use
Appendectomy - statistics & numerical data
Appendicitis - diagnostic imaging
Appendicitis - drug therapy
Appendicitis - surgery
Appendicular mass
Child
Child, Preschool
Conservative Treatment
Early appendectomy
Female
Humans
Male
Pediatrics
Prospective Studies
Surgery
Surgery complications
Treatment Outcome
Ultrasonography
Unnecessary Procedures
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Summary:Abstract Purpose An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. Methods Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24–48 h it was worsening, the conservative approach failed and patients underwent late surgery. Results A total of 362 pediatric patients were included. 165 underwent early appendectomy. 197 patients were at first treated conservately: of theese, 82 were operated within 24–48 h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound. Conclusions Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservately; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure. Type of study: treatment study. Level of evidence: II
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2016.08.007