Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study

URN to cite this document:: urn:nbn:de:bvb:355-epub-581443
DOI to cite this document:: 10.5283/epub.58144

Reis Wolfertstetter, Patricia ; Ebert, John Blanford ; Barop, Judith ; Denzinger, Markus ; Kertai, Michael ; Schlitt, Hans J.

; Knorr, Christian

License: Creative Commons Attribution 4.0
PDF - Published Version
(1MB)

Date of publication of this fulltext: 23 Apr 2024 08:23

Alternative links to fulltext:DOI Publisher

Details

Preview

Export bibliographical data

Abstract

Abstract

Background: Simple appendicitis may be self-limiting or require antibiotic treatment or appendectomy. The aim of this study was to assess the feasibility and safety of a nonoperative, antibiotic-free approach for suspected simple appendicitis in children. Methods: This single-center, retrospective study included patients (0–17 years old) who were hospitalized at the pediatric surgery department due to suspected appendicitis between 2011 and 2012. Data from patients who primarily underwent appendectomy were used as controls. The follow-up of nonoperatively managed patients was conducted in 2014. The main outcome of interest was appendicitis recurrence. Results: A total of 365 patients were included: 226 were treated conservatively and 139 underwent appendectomy. Fourteen (6.2% of 226) of the primarily nonoperatively treated patients required secondary appendectomy during follow-up, and histology confirmed simple, uncomplicated appendicitis in 10 (4.4% of 226) patients. Among a subset of 53 patients managed nonoperatively with available Alvarado and/or Pediatric Appendicitis Scores and sonographic appendix diameters in clinical reports, 29 met the criteria for a high probability of appendicitis. Three of these patients (10.3% of 29) underwent secondary appendectomy. No complications were reported during follow-up. Conclusions: A conservative, antibiotic-free approach may be considered for pediatric patients with suspected uncomplicated appendicitis in a hospital setting. Only between 6 and 10% of these patients required secondary appendectomy. Nevertheless, the cohort of patients treated nonoperatively was likely to have also included individuals with further abdominal conditions other than appendicitis. Active observation and clinical support during the disease course may help patients avoid unnecessary procedures and contribute to spontaneous resolution of appendicitis or other pediatric conditions as the cause of abdominal pain. However, further studies are needed to define validated diagnostic and management criteria.

Owner only: item control page

Download Statistics

Altmetric

Alternative Statistics (altmetrics)

More literature (via CORE)

Details

Preview

Export bibliographical data

Abstract

Abstract

Download Statistics

Downloads

Alternative Statistics (altmetrics)

More literature (via CORE)

University Library