The treatment of complicated appendicitis in children. What is the gold standard?
From 1976 to 1985, 233 consecutive children were treated for appendicitis by a standardized protocol. Forty-nine percent of these cases were complicated: 11% by gangrene, 33% by perforation, and 4% by perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of administration of ampicillin sodium, gentamicin sulfate, and clindamycin phosphate; appendectomy; and saline peritoneal irrigation. Transperitoneal drainage was not used. Skin and subcutaneous tissues were left open for delayed primary wound closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. The only infectious complication was one intra-abdominal abscess. There were no wound infections or deaths. The rate of infectious complications was 0.9%, and the overall morbidity was 4.4%. This standardized treatment of complicated appendicitis in children prevents wound infection and significantly decreases the incidence of intra-abdominal abscess formation and mortality.
D000038:Abscess / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D001424:Bacterial Infections / Q000382:microbiology; D004322:Drainage; D006801:Humans; D007416:Intestinal Perforation / Q000382:microbiology / Q000601:surgery*; D007432:Intraoperative Period; D011292:Premedication; D012422:Rupture, Spontaneous; D013530:Surgical Wound Infection / Q000517:prevention & control
D000900:Anti-Bacterial Agents