title: Complicated appendicitis in children: a clear role for drainage and delayed appendectomy.
abstract: BACKGROUND
  Children presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy.
  
  
  METHODS
  A retrospective review of all children undergoing appendectomy over a 5-year period was performed.
  
  
  RESULTS
  We identified 1,106 children: 360 had evidence of perforation and 92 had an intra-abdominal abscess or right lower quadrant phlegmon. Of these 92, 60 underwent primary appendectomy and 32 underwent drainage and/or antibiotic therapy with delayed appendectomy. Children undergoing delayed appendectomy had a longer prodrome of symptoms (6.9 vs 4.6 days, P = .002), slightly higher presenting white blood cell count (19.3 vs 16.6, P = .08), and had the same hospital length of stay, yet had a lower complication rate requiring readmission to the hospital (0% vs 10%) compared to those undergoing immediate appendectomy.
  
  
  CONCLUSIONS
  In children presenting with prolonged symptoms and a discrete appendiceal abscess or phlegmon, drainage and delayed appendectomy should be the treatment of choice.
authors.affiliation: Department of Surgery, The University of Colorado Health Sciences Center, 4200 E. 9th Ave, Denver, CO 80262, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Roach
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bruny
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Allshouse
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Karrer
authors.forename: Moritz M
authors.initials: MM
authors.lastname: Ziegler
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002481:Cellulitis / Q000209:etiology*; D002648:Child; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D006801:Humans; D007416:Intestinal Perforation; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents