title: Comparison of critical conservative treatment versus emergency operation in children with ruptured appendicitis with tumor formation.
abstract: OBJECTIVE
  Management of ruptured appendicitis with tumor formation in children includes emergency appendectomy or initial conservative treatment, the choice of which remains controversial. This study compared the clinical courses of children with ruptured appendicitis with tumor formation (RATF) who received emergency appendectomy or initial conservative management.
  
  
  METHODS
  A retrospective study was conducted of 59 pediatric patients with RATF treated from January 1996 to September 2002. Twenty seven patients received emergency appendectomy and 32 patients received initial conservative treatment. Patients who received initial conservative treatment were further divided into those who recovered from the initial conservative treatment (n = 23) and those 9 patients who failed initial conservative treatment and received appendectomy at the same admission. Clinical factors including age, gender, body weight, duration of symptoms, duration of ileus after initial treatment, duration of fever and the usage of antibiotics, hospital stays, and major and minor complications were compared between groups.
  
  
  RESULTS
  The emergency appendectomy group and initial conservative treatment group had similar distributions of age, gender, body weight, and duration of symptoms. Patients who received emergency appendectomy had a shorter duration of fever (2.7 +/- 1.9 vs 8.0 +/- 7.0 days; p = 0.003) but were fed later (4.4 +/- 3.9 vs 1.8 +/- 2.9 days; p = 0.005) compared with those who received conservative treatment initially. Patients who received emergency appendectomy also had a higher complication rate (33.3% vs 17.4%; p = 0.038). Patients who recovered from initial conservative treatment were fed earlier after operation (0.7 +/- 0.6 vs 4.2 +/- 4.1 days; p = 0.002), had a lower complication rate (33.3% vs 4.3%; p = 0.02) and a shorter hospital stay (16.6 +/- 10.9 vs 29.3 +/- 33.6 days; p = 0.03) than those who failed initial conservative treatment. Histopathological study of the appendix in the 17 patients who received interval appendectomy showed fecal materials (58.8%) and fecoliths (29.4%) in lumen, microscopically suppurative inflammation (31.3%), and focal mild inflammation (31.3%).
  
  
  CONCLUSIONS
  In this study, conservative treatment of RATF in children was associated with a lower complication rate. Pathological analysis of the appendix suggests that interval appendectomy should be advocated in patients with successful initial conservative treatment.
authors.affiliation: Department of Surgery, National Taiwan University Hospital and College of Medicine, No. 7 Chung-Shan S. Road, Taipei 100, Taiwan.
authors.forename: Cheng-Maw
authors.initials: CM
authors.lastname: Ho
authors.forename: Yun
authors.initials: Y
authors.lastname: Chen
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.forename: Wen-His
authors.initials: WH
authors.lastname: Lin
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Hsu
authors.forename: Wei-Jao
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001063:Appendiceal Neoplasms / Q000628:therapy*; D001064:Appendicitis / Q000473:pathology / Q000628:therapy*; D002648:Child; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents