Is delayed operative treatment worth the trouble with perforated appendicitis is children?
BACKGROUND
Approximately 30% to 50% of appendicitis in children is already perforated at presentation. The optimal management of these children remains controversial.


METHODS
Ninety-six children (aged 2 to 16 years) were treated for perforated appendicitis. Seventy-one underwent immediate appendectomy and drainage of abscess, if present (group I). In the other 25 an attempt was made to treat with intravenous antibiotics, combined with transrectal (4) or percutaneous (2) drainage of abscess. This treatment was successful in 16 patients (group II), who underwent appendectomy 6 to 8 weeks later, and unsuccessful in 9 patients (group III), who underwent appendectomy 3 to 12 days later.


RESULTS
The mean length of stay was as follows: group I, 6.7 days; group II, 8.9 days; and group III, 10.9 days (not significant). The white blood cell count (WBC) at presentation was group I, 18.6 K; group II, 17.9 K; group III, 18.8 K. The percent fall of WBC on day 4 was group I, 55%; group II, 25.5%; group III, 17% (P >0.05 versus groups I and II). Twenty of 71 patients in group I (28%) developed wound infection (5), pelvic abscess (14), and pancreatitis (1), while 2 of 16 (12.5%) of group II and 1 of 9 (11%) of group III patients required readmission (both P <0.05 versus group I).


CONCLUSIONS
These data show that initial antibiotic treatment of perforated appendicitis in children, followed by interval appendectomy, is useful for a select group who present with little or no peritonitis, slightly elevated temperature, and WBC that falls at least 25% within 3 to 4 days.
Weber
Thomas R
TR
Department of Surgery, Division of Pediatric Surgery, Saint Louis University School of Medicine, and Cardinal Glennon Children's Hospital, St. Louis, MO 63104, USA. Weberm2@slu.edu
Keller
Martin A
MA
Bower
Richard J
RJ
Spinner
Grace
G
Vierling
Kim
K
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001062:Appendectomy; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications
D000900:Anti-Bacterial Agents