Non-operative management of early, acute appendicitis in children: is it safe and effective?
OBJECTIVE
The purpose of this study was to determine if early, acute appendicitis in children can be safely and effectively managed with antibiotics alone.


METHODS
A retrospective review was performed of children (<18 yrs) treated non-operatively (NOM) for early, acute appendicitis since May 2012. These were compared to patients treated with appendectomy between January 2011 and October 2011 (OM). Inclusion criteria included: (a) symptoms <48 h, (b) localized peritonitis, and (c) ultrasound findings consistent with early, acute appendicitis.


RESULTS
Twelve patients (66% female, mean age 12.2,SD=4.2 yrs) were treated non-operatively, while 12 (50% female, mean age 12.5,SD=3.2 yrs) were treated operatively. Two NOM children (16.7%) required initial appendectomy. One patient developed recurrent appendicitis requiring appendectomy 7 months post-discharge. Four other NOM patients returned with symptoms but did not require admission or surgery. Two OM patients (8.3%) had hospital visits and admissions related to surgical site infections. Mean length of stay (LOS) for the first visit was 1.5 days (SD=1.0d) (NOM) vs. 1.3 days (SD=0.5d) (OM) (p=0.61). Including first and subsequent admissions, mean LOS was 1.8 days (SD=1.1d) (NOM) vs. 1.7 days (SD=1.5d) (OM) (p=0.97).


CONCLUSIONS
Early acute appendicitis in appropriately selected children can be successfully treated non-operatively. Randomized trials with longer follow-up are required.
Division of General Surgery, Western University, London Health Sciences Centre, London, Ontario.
Jeff
J
Armstrong
Division of Pediatric Surgery, Western University, Children's Hospital, London, Ontario.
Neil
N
Merritt
Division of Pediatric Surgery, Western University, Children's Hospital, London, Ontario.
Sarah
S
Jones
Division of Pediatric Surgery, Western University, Children's Hospital, London, Ontario.
Leslie
L
Scott
Division of Pediatric Surgery, Western University, Children's Hospital, London, Ontario. Electronic address: Andreana.butter@lhsc.on.ca.
Andreana
A
Bütter
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission; D012008:Recurrence; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Antibiotics; Appendicitis; Non-operative management