Acute appendicitis in children: not only surgical treatment.
OBJECTIVE
An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery.


METHODS
Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated. Complicated appendicitis underwent early surgery; uncomplicated appendicitis started conservative treatment with antibiotic. If in the next 24-48h it was worsening, the conservative approach failed and patients underwent late surgery.


RESULTS
A total of 362 pediatric patients were included. One hundred sixty-five underwent early appendectomy; 197 patients were at first treated conservatively: of these, 82 were operated within 24-48h for failure. The total percentage of operated patients was 68.2%. An elevated association was found between surgery and ultrasound.


CONCLUSIONS
Conservative treatment for uncomplicated appendicitis had high percentage of success (58%). Complications in operated patients were infrequent. Our protocol was effective in order to decide which patients treat early surgically and which conservatively; specific red flags (age and onset) can identified patients at most risk of complications or conservative failure.


METHODS
treatment study.


METHODS
II.
Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy. Electronic address: annacaruso2@libero.it.
Anna Maria
AM
Caruso
Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy.
Alessandro
A
Pane
Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy.
Roberto
R
Garau
Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy.
Pietro
P
Atzori
Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy.
Marcello
M
Podda
Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy.
Alessandra
A
Casuccio
Pediatric Surgical Unit, SS Trinità Hospital, Cagliari, Italy.
Luigi
L
Mascia
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D019564:Unnecessary Procedures
D000900:Anti-Bacterial Agents
Abdominal ultrasound; Acute appendicitis; Appendicular mass; Conservative treatment; Early appendectomy; Surgery complications