title: Nonoperative management of pediatric ruptured appendix with inflammatory mass or abscess: presence of an appendicolith predicts recurrent appendicitis.
abstract: OBJECTIVE
  The aim of this study was to determine if the presence of an appendicolith is associated with an increased risk for recurrent appendicitis after nonoperative treatment of pediatric ruptured appendix with inflammatory mass or abscess.
  
  
  METHODS
  Ninety-six pediatric patients (52 girls, 44 boys), aged 16 months to 17 years (average, 7 years), were managed between 1980 and 2003. All were treated nonoperatively with intravenous triple antibiotics for 5 to 21 days. All children had at least a 2-year follow-up. This study was approved by the hospital research ethics board.
  
  
  RESULTS
  Six children (6%) who became worse and 41 (46%) who had an interval appendectomy were eliminated from the study. The other 49 patients comprised the study group and received no further treatment. Twenty-eight (57%) had no recurrence, and 21 (43%) had a recurrence within 1 month to 2 years (average, 3 months). In the study group, 31 (63%) children had no appendicolith on radiological imaging and 18 (37%) had. Presence of an appendicolith was associated with a 72% rate of recurrent appendicitis compared with a recurrence rate of 26% in those with no appendicolith (chi2 test, P < .004).
  
  
  CONCLUSIONS
  We conclude that the patients with appendicolith should have an interval appendectomy.
authors.affiliation: Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada. a_ein@istar.ca
authors.forename: Sigmund H
authors.initials: SH
authors.lastname: Ein
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
authors.forename: Alan
authors.initials: A
authors.lastname: Daneman
mesh_terms: D018784:Abdominal Abscess / Q000150:complications*; D000293:Adolescent; D001064:Appendicitis / Q000209:etiology* / Q000628:therapy*; D001065:Appendix; D002137:Calculi / Q000150:complications*; D002429:Cecal Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012008:Recurrence