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Expanded utilization of nonoperative management for complicated appendicitis in children

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Abstract

Purpose

The initial approach to complicated appendicitis in children has become increasingly nonoperative, particularly when there is presumed perforation and a localized abscess. We extended the indications for nonoperative management to include most cases other than simple appendicitis, including those with diffuse peritoneal involvement. We evaluated outcomes and sought to identify factors at the time of hospital admission that predicted an extended length of stay (LOS) with this strategy.

Methods

The records of 223 consecutive children who were managed nonoperatively for complicated appendicitis were reviewed. A conservative approach was typically pursued in those with an abscess, phlegmon, or free fluid on initial imaging studies, and diffuse tenderness, diarrhea, or significant leukocytosis after 2 days of symptoms. Interval appendectomies were performed selectively.

Results

The average LOS was 5.6 days (1–38), but nine subjects had a LOS of greater than 14 days. Eleven (4.9 %) required appendectomy during the initial admission. Free fluid on admission imaging studies, present in 78 % of those with an extended LOS, [odds ratio (OR) 5.5], in addition to a requirement for early nasogastric drainage (OR 24.2) and a higher band count (19 vs 15 %), was significantly associated with an extended LOS.

Conclusions

An expansion of the indications for nonoperative management of complicated appendicitis yielded an acceptable average LOS and a low incidence of early appendectomy. However, a small subset of subjects had an extended LOS, and most of those had free peritoneal fluid on admission.

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References

  1. Henry MCW, Gollin G, Islam S et al (2007) Matched analysis of nonoperative management vs immediate appendectomy for perforated appendicitis. J Pediatr Surg 42:19–24

    Article  PubMed  Google Scholar 

  2. Nadler EP, Reblock KK, Vaughan KG et al (2004) Predictors of outcome for children with perforated appendicitis initially treated with non-operative management. Surg Infect 5:349–356

    Article  Google Scholar 

  3. Kogut KA, Blakely ML, Schropp KP et al (2001) The association of elevated percent bands on admission with failure and complications with failure and complications of interval appendectomy. J Pediatr Surg 36:165–168

    Article  PubMed  CAS  Google Scholar 

  4. Vane DW, Fernandez N (2005) Role of interval appendectomy in the management of complicated appendicitis in children. World J Surg 30:51–54

    Article  Google Scholar 

  5. Aprahamian CJ, Branhart DC, Bledsoe SE et al (2007) Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences. J Pediatr Surg 42:934–938

    Article  PubMed  Google Scholar 

  6. Whyte C, Levin T, Harris BH (2008) Early decisions in perforated appendicitis in children: lessons from a study of nonoperative management. J Pediatr Surg 43:1459–1463

    Article  PubMed  Google Scholar 

  7. Keckler SJ, Tsao K, Sharp SW et al (2008) Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess. J Pediatr Surg 43:977–980

    Article  PubMed  Google Scholar 

  8. St. Peter SD, Aguayo A, Fraser JD et al (2010) Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 45:236–240

    Article  PubMed  Google Scholar 

  9. Ein SH, Shandling B (1996) Is interval appendectomy necessary after rupture of an appendiceal mass? J Pediatr Surg 31:849–850

    Article  PubMed  CAS  Google Scholar 

  10. Puapong D, Lee SL, Haigh PI et al (2007) Routine interval appendectomy in children is not indicated. J Pediatr Surg 42:1500–1503

    Article  PubMed  Google Scholar 

  11. St. Peter SD, Sharo SW, Holcomb GW et al (2008) An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg 43:2242–2245

    Article  PubMed  Google Scholar 

  12. Williams N, Kapila L (1994) Acute appendicitis in the under-5 year old. JR Coll Surg Edinb 39:168–170

    CAS  Google Scholar 

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Correspondence to Gerald Gollin.

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Fawley, J., Gollin, G. Expanded utilization of nonoperative management for complicated appendicitis in children. Langenbecks Arch Surg 398, 463–466 (2013). https://doi.org/10.1007/s00423-012-1042-5

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  • DOI: https://doi.org/10.1007/s00423-012-1042-5

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