Interval appendectomy for perforated appendicitis in children.
To determine the efficacy, safety, and cost of managing perforated appendicitis with intravenous antibiotics followed by an interval appendectomy, the charts of 87 children with ruptured appendicitis were retrospectively reviewed. These patients were treated with intravenous fluid resuscitation and antibiotics (consisting of clindamycin and ceftazidime) and underwent appendectomy, either on that admission (n = 46) or as a delayed interval procedure (n = 41). Antibiotics in all cases were discontinued either at home or in the hospital after the child was a febrile for 48 hours with normal white and differential blood cell counts, and the two groups were compared. Seven patients (17%) "failed" the interval appendectomy protocol. All but one "failure" was due to the development or persistence for >72 hours of a bowel obstruction. The data are described below as percent or mean +/- 1 standard deviation. [table: see text] We conclude that antibiotics and interval appendectomy is a safe effective alternative for the management of perforated appendicitis. When successful, hospitalization, charges, and morbidity are less with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.
Section of Pediatric Surgery, University of Tennessee, Le Bonheur Children's Medical Center, Memphis 38105, USA.
A J
AJ
Bufo
R S
RS
Shah
M H
MH
Li
N A
NA
Cyr
R S
RS
Hollabaugh
S D
SD
Hixson
K P
KP
Schropp
O E
OE
Lasater
R E
RE
Joyner
T E
TE
Lobe
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002442:Ceftazidime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy; D017722:Hospital Charges; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002442:Ceftazidime