Appendicitis diagnosed following active observation does not increase morbidity in children

Abstract

An audit was undertaken to assess the outcome of patients aged less than 16 years who underwent appendicectomy after active obsevation. A comparison was made of the incidence of perforation, complications, and hospital stay of patients who underwent emergency appendicectomy (group A) and those who were operated upon after active observation (group B). A total of 1,672 patients were admitted with acute abdominal pain. Emergency appendicectomy following the diagnosis of acute appendicitis on admission was performed in 744 patients (group A); an appendicectomy was performed in 123 patients following active observation (group B). In group A, 140 patients (18.8%) were found to have macroscopic or microscopic perforations; a normal appendix was removed in 75 (10.1%) cases and 31 (4.2%) patients developed postoperative complications. In group B, perforations occurred in 19 (15.1%) patients, normal appendix was encountered in 25 (19.8%), and postoperative complications occured in 7 (5.5%). The overall normal appendicectomy rate was 11.5%. Mean duration of hospital stay was 3.5 days in group A and 4.7 days in group B. The remaining patients who were actively observed and did not require surgery were discharged when their symptoms and signs had resolved. The study illustrates that appendicectomy after a period of active observation in hospital fro acute abdominal pain carries no increase in morbidity compared with urgent appendicectomy.