Abstract
Purpose
The incidence of perforation during antibiotic therapy (AT) of children triaged as non-complicated acute appendicitis (NC-Ap) was investigated.
Methods
Abdominal ultrasonography (US) and/or computed tomography (CT) scans from cases of perforation identified at appendectomy for failed AT were reassessed blindly by a panel of board-certified specialists for any evidence of pre-AT morbidity suggestive of perforation.
Results
Of 521 cases triaged as NC-Ap, symptoms resolved with AT in 452 cases (86.8%). All 69/521 (13.2%) cases with persistent symptoms had urgent appendectomy, and 12/521 (2.3%) were found to have perforated. Blind reassessment of US and/or CT scans from these cases identified seven with evidence of perforation when they were triaged as NC-Ap. Thus, the actual incidence of perforation during AT for NC-Ap was actually 12–7 = 5/521 (0.95%).
Conclusions
Perforation is generally believed to be a complication of AT, but inappropriate triaging of cases for AT can bias results by artificially inflating the number of perforations, in this study, by more than double. We are the first to assess the unbiased incidence of perforation during AT for NC-Ap, by reassessing pre-AT US and/or CT scans. The incidence of perforation during AT is actually negligible.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Renita RM, Peter SDS et al (2017) Contemporary management of appendicitis in children. Adv Pediatr 64:225–251
Kaneko K, Tsuda M (2004) Ultrasound-based decision making in the treatment of acute appendicitis in children. J Pediatr Surg 39:1316–1320
Abes M, Petik B, Kazıl S (2007) Nonoperative treatment of acute appendicitis in children. J Pediatr Surg 42(8):1439–1442
Koike Y, Uchida K, Matsushita K et al (2014) Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial successful non-operative management of uncomplicated appendicitis in pediatric patients. J Pediatr Surg 49:1116–1121
Armstrong J, Merritt N, Jones S et al (2014) Non-operative management of early, acute appendicitis in children: is it safe and effective? J Pediatr Surg 49(5):782–785
Gorter RR, van der Lee JH, Cense HA et al (2015) Initial antibiotic treatment for acute simple appendicitis in children is safe: Short-term results from a multicenter, prospective cohort study. Surgery 157:916–923
Hartwich J, Luks FI, Watson-Smith D et al (2016) Nonoperative treatment of acute appendicitis in children: a feasibility study. J Pediatr Surg 51:111–116
Svensson JF, Patkova B, Almstrom M et al (2015) Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children. Ann Surg 261:67–71
Minneci PC, Mahida JB, Lodwick DL et al (2016) Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg 151(5):408–415
Tanaka Y, Uchida H, Kawashima H et al (2015) Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis. J Pediatr Surg 50:1893–1897
Caruso AM, Pane A, Garau R et al (2017) Acute appendicitis in children: not only surgical treatment. J Pediatr Surg 52:444–448
Bachur RG, Lipsett SC, Monuteaux MC (2017) Outcomes of nonoperative management of uncomplicated appendicitis. Pediatrics 140(1):e20170048
Scott A, Lee S, DeUgarte D et al (2018) Nonoperative management of appendicitis. Clin Pediatr 57(2):200–204
Miyano G, Ochi T, Seo S et al (2018) Factors affecting non-operative management of uncomplicated appendicitis in children: should laparoscopic appendectomy be immediate, interval, or emergency? Asian J Endosc Surg. https://doi.org/10.1111/ases.12677
Lee S, Spence L, Mock K et al (2018) Expanding the inclusion criteria for nonoperative management of uncomplicated appendicitis: outcomes and cost. J Pediatr Surg 53:42–47
Steiner Z, Buklan G, Gutermacher M et al (2018) Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible. Pediatr Surg Int 34:283–288. https://doi.org/10.1007/s00383-018-4226-4
Jimbo K, Takeda M, Miyata E et al (2016) Is a pediatrician performed gray scale ultrasonography with power Doppler study safe and effective for triaging acute non-perforated appendicitis for conservative management? J Pediatr Surg 51:1952–1956
Beltran MA, Almonacid J, Vicencio A et al (2007) Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pediatr Surg 42:1208–1214
Acknowledgements
There are no acknowledgements. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mikami, T., Sueyoshi, R., Kosaka, S. et al. Perforation in pediatric non-complicated appendicitis treated by antibiotics: the real incidence. Pediatr Surg Int 36, 69–74 (2020). https://doi.org/10.1007/s00383-019-04574-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-019-04574-2