Appendicitis in children: a ten-year update of therapeutic recommendations.
OBJECTIVE
In 1990, the authors reported excellent outcomes using a standard protocol to treat pediatric appendicitis. This protocol has been simplified further and a large retrospective review was conducted to assess current outcomes.


METHODS
All patients treated for presumed appendicitis between April 1997 and December 1999 were reviewed. All patients received preoperative gentamicin and clindamycin. Patients with complicated appendicitis received postoperative ampicillin, gentamicin, and clindamycin or metronidazole. All wounds were closed primarily without drains. Patients with complicated appendicitis were discharged when their ileus resolved, they remained afebrile for 24 hours, and had a normal leukocyte count.


RESULTS
A total of 648 patients were reviewed. A total of 9.4% of appendices were pathologically normal, 55.6% were simple acute, 15.7% were gangrenous, and 19.3% were perforated. Hospital stay was 2.21 +/- 2.04 days for normal, 1.39 +/-.89 for simple acute, 2.97 +/- 1.25 for gangrenous, and 6.31 +/- 3.51 days for perforated appendices. There were no wound infections in patients with normal or simple acute appendices. Two minor intraabdominal infections (0.56%) occurred in patients with simple appendicitis. Patients with complicated appendicitis (gangrenous or perforated) had wound infection and intraabdominal infection rates of 2.6% and 4.4%, respectively.


CONCLUSIONS
The authors' current protocol results in reasonable hospital stays and good outcomes. It serves as an evidence-based standard of care for the treatment of pediatric appendicitis.
Emil
Sherif
S
Division of Pediatric General Surgery, Department of Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Laberge
Jean-Martin
JM
Mikhail
Peter
P
Baican
Livia
L
Flageole
Helene
H
Nguyen
Luong
L
Shaw
Kenneth
K
D018784:Abdominal Abscess / Q000453:epidemiology / Q000517:prevention & control; D000208:Acute Disease; D000293:Adolescent; D000667:Ampicillin / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007958:Leukocyte Count; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome
D005839:Gentamicins; D008795:Metronidazole; D002981:Clindamycin; D000667:Ampicillin