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PubMed1990

Evaluation of women with possible appendicitis using technetium-99m leukocyte scan.

The authors evaluated the use of technetium-99m albumin colloid white blood cell (TAC-WBC) scan in women with possible appendicitis. One hundred and nine women underwent 110 TAC-WBC scans. One woman had a second scan on a separate admission and was considered two individual patients in the analysis. Twenty-six women had appendicitis, 10 of whom had a perforated appendix at surgery. The TAC-WBC scan was indeterminate (abnormal but nondiagnostic for appendicitis) in 52 women (47%), nine of whom had appendicitis. Fifty-eight scans were read as positive or negative for appendiceal pathology. There were 16 true positives, 5 false positives, 36 true negatives, and 1 false negative. The predictive value of a positive scan was 76%, and the predictive value of a negative scan was 97%. The TAC-WBC scan was positive in 62% of patients with appendicitis and negative in 43% of the patients without appendicitis resulting in an overall accuracy of 47% in the 109 women. The main value of TAC-WBC scan in women with possible appendicitis is its high negative predictive value and the main problem with the TAC-WBC scan is its high indeterminate rate.

Abdominal Pain↗
PubMed2003

An assessment of the severity of recurrent appendicitis.

BACKGROUND: This study examines the clinical characteristics of patients who developed recurrent appendicitis after previous nonoperative management of perforated appendicitis. METHODS: Retrospective chart review was performed, and data from the recurrent and initial episode of appendicitis were collected. RESULTS: In all, 237 patients from 1989 to 2001 were managed nonoperatively for perforated appendicitis and 32 (14%) were readmitted for recurrent appendicitis. Median white blood cell count at recurrence was 9.5 (interquartile range [IQR]: 6.6 to 13.2] versus 13.1 [IQR: 10.8 to 16.1] at initial presentation (P = 0.002). Maximum temperature was 98.6 degrees F [IQR: 98.2 to 100.5] at recurrence versus 100.3 degrees F [IQR: 99.5 to 101.5] (P = 0.008). Median time for intravenous antibiotics use was 3 [IQR: 3 to 7] days at recurrence versus 6 [IQR: 4 to 8] days initially (P = 0.01). Inpatient stay was also shorter; median length was 6 [IQR: 3 to 8] days compared with 7 [IQR: 5 to 9] days at initial presentation (P = 0.02). CONCLUSIONS: Patients managed nonoperatively for perforated appendicitis who later developed recurrent appendicitis exhibited a milder clinical course at recurrence. Elective interval appendectomy may be reserved until a recurrent episode.

Adult↗
PubMed2004

Ultrasound-based decision making in the treatment of acute appendicitis in children.

BACKGROUND/PURPOSE: Imaging techniques are used widely to diagnose appendicitis. However, the negative appendectomy rate remains at about 15%. The authors assessed ultrasound-based decision making in the treatment of acute appendicitis in children. METHODS: The authors prospectively studied 165 consecutive children (3 to 15 years old) evaluated for appendicitis. Diagnosis and treatment were based solely on ultrasound scan findings. Criterion for appendicitis was a diameter exceeding 6 mm. Severity was classified into 4 grades based on the appearance of intramural appendiceal structure. Patients with grades I or II received antibiotic therapy. Patients with grades III or IV underwent appendectomy. RESULTS: Ultrasound scan diagnosed appendicitis in 93 children (grade I, 7; grade II, 17; grade III, 41; and grade IV, 28). All but 2 patients with grades I or II underwent antibiotic therapy without complication. All grades III or IV patients underwent appendectomy. There was no negative appendectomy among 76 appendectomies during this period. Ultrasound-based prediction of severity was correct in 67 cases (88%). Ultrasonography identified other pathology in 39. CONCLUSIONS: Ultrasonography in children cannot only visualize all inflamed appendices but also predict severity of disease. Treatment based entirely on ultrasound scan identified patients who required surgery for severe appendicitis and permitted successful conservative treatment for mild appendicitis.

Abdominal Pain↗
PubMed2004

Diagnosing suspected acute nonclassic appendicitis with sulesomab, a radiolabeled antigranulocyte antibody imaging agent.

PURPOSE: The aim of this study was to investigate the potential role of a technetium 99m-labeled antigranulocyte murine antibody Fab' fragment (sulesomab) as a diagnostic imaging agent in children with suspected acute nonclassic appendicitis. METHODS: Serial planar images at 15 to 30 minutes, 1, 2, and 4 hours and single-photon emission computed tomography (SPECT) images were acquired after sulesomab injection. In 40 children with suspected acute nonclassic appendicitis, imaging results were confirmed surgically in 21 patients, whereas 19 nonsurgical patients resolved presenting signs and symptoms and were considered to not have appendicitis. RESULTS: Sulesomab imaging had 95% sensitivity, 90% specificity, 95% negative predictive value, and 90% positive predictive value for acute appendicitis. In 78% of patients, sulesomab accurately detected or excluded acute appendicitis and would have changed management plans. No patients had adverse events, and no human antimurine antibody response occurred in 18 evaluable patients. CONCLUSIONS: Sulesomab was well tolerated with no side effects and with no apparent immunogencity. Appendicitis was rapidly and accurately detected. In pediatric patients with suspected nonclassic appendicitis, management decisions incorporating sulesomab imaging provided benefit in separating surgical from nonsurgical patients.

Acute Disease↗
PubMed2005

Is early laparoscopic appendectomy feasible in children with acute appendicitis presenting with an appendiceal mass? A prospective study.

BACKGROUND: The management of an appendiceal mass remains controversial with 2 schools of thought; early surgical intervention vs nonoperative management with or without interval appendectomy. The aim is to determine the role and safety of early laparoscopic appendectomy (LA) in children with acute appendicitis presenting with an appendiceal mass. METHODS: This is a prospective study of 88 consecutive pediatric patients who underwent attempted LA for suspected acute appendicitis at KK Women's and Children's Hospital, Singapore, between May and October 2003. RESULTS: A total of 88 patients with a mean age of 10 +/- 3 years (range, 3-16 years) underwent LA for an appendiceal mass (n = 22), simple appendicitis (n = 36), other complicated (gangrenous or perforated) appendicitis (n = 23), and a normal appendix (n = 7). There were 7 conversions to open appendicectomy, 3 of which occurred in patients with an appendiceal mass. There were no perioperative or postoperative mortalities. Morbidity occurred in only one patient who underwent LA for perforated appendicitis. He had prolonged sepsis that resolved after 2 weeks of intravenous antibiotics. None of the patients with an appendiceal mass developed complications. Patients who underwent early LA for an appendiceal mass had a statistically significant (P < .05) longer operating time (median, 103 minutes; interquartile range, 90-151 minutes, vs median, 87 minutes; interquartile range, 71-112 minutes), prolonged time to ambulation (median, 2.0 days; interquartile range, 2-2.5 days, vs median, 1.0 days; interquartile, 1-2 days), increased time to resumption of diet (median, 4 days; interquartile, 3-5 days, vs median, 2 days; interquartile, 2-3 days), and longer postoperative stay (median, 6.0 days; interquartile, 5.5-6.5 days, vs median, 4.0 days; interquartile, 3-5.5 days) compared with patients presenting with appendicitis without mass formation. However, there was no statistical difference in these parameters when LA for an appendiceal mass was compared with LA for other complicated appendicitis (perforated and gangrenous). CONCLUSION: Although early LA for an appendiceal mass is a technically demanding procedure, it can be performed safely in children with minimal morbidity and mortality. In an era where patients' demand for "key-hole" surgery is rising, early LA is a safe and viable option in the management of children with an appendiceal mass. It also offers the advantage of avoiding misdiagnoses and the need for a second hospitalization.

Acute Disease↗
PubMed2001

Comparison of open and laparoscopic treatment of acute appendicitis.

BACKGROUND: Appendectomy can be performed using either a laparoscopic or an open technique. This study compares the outcome of patients treated for acute appendicitis by open appendectomy with the outcome of those undergoing laparoscopic appendectomy. METHODS: Patients undergoing appendectomy at The Mount Sinai Hospital between 1994 and 1998 were studied. Outcome of patients having open appendectomy was compared with that of patients having laparoscopic appendectomy. RESULTS: Seven hundred fifty-eight patients underwent appendectomy for acute appendicitis during the 5-year study period. Two hundred seventy-one (36%) had open appendectomy and 487 (64%) had laparoscopic appendectomy. Patients subsequently found to have a normal appendix had the highest rate of laparoscopic appendectomy, whereas those with gangrenous appendicitis were most likely to have open appendectomy (P <0.05). There was a significant decline in the postoperative length of stay for open cases during the length of the study. In the final year, the difference in length of stay between open and laparoscopic appendectomy was only 1 day. Patients with gangrenous appendicitis had a significantly longer length of stay than did patients with a normal appendix or suppurative appendicitis. The hospital cost of laparoscopic appendectomy was greater than that for open appendectomy but the extra expenditure in the operating room was offset by the longer length of stay of the patients having open surgery. CONCLUSIONS: Differences in outcome between open and laparoscopic appendectomy are minor. In this study, more difficult cases with gangrenous appendicitis were more likely to require open appendectomy whereas milder forms of appendicitis, especially in women, were more likely to be treated by laparoscopy. Savings from the slightly shorter hospital stay after laparoscopic appendectomy are offset by the higher surgical cost of the laparoscopic equipment.

Acute Disease↗
PubMed1999

The diagnosis of appendicitis during pregnancy and maternal and fetal outcome after appendectomy.

OBJECTIVE: A review of the literature reveals contradictive conclusions regarding appendicitis during pregnancy due to the few patients included in previous reports. METHODS: From 1980 to 1985, the Danish National Patient Registry identified the patients having the WHO codes Y60 (pregnancy), 54000 (acute appendicitis) and the operation code 43 000 (appendectomy). Each patient's file was reviewed by the authors. RESULTS: The ratio of appendicitis (n = 58) to appendectomy (n = 117) was 50%. The appendicitis group was significantly older (26.2 years) than the normal appendix group (23.8 years). Second trimester had the highest incidence of appendicitis, perforated appendicitis and normal appendix. No effect of tocolytic agents could be demonstrated. No maternal mortality. Obstetrical complications were few and appeared only in the group having a normal appendix and first after discharge. CONCLUSIONS: Pregnant women suspected of having appendicitis should be evaluated as non-pregnant women. Use of tocolytic agents is a matter of choice. Obstetrical complications are few and not related to the surgical trauma.

Adolescent↗
PubMed1996

Appendicitis in children in the managed care era.

Acute appendicitis is the most common condition requiring emergency operation in children. Late appendicitis is still a major source of morbidity and potential mortality. It has been suggested that managed care programs are responsible for a delay in surgical referral and consequently an increased risk of morbidity and mortality. In light of the increasing use of managed care, the authors reviewed their experience with pediatric acute appendicitis in managed care and indemnity insurance patients. The charts of all pediatric appendectomy patients treated between January 1990 and March 1995 were reviewed. Payor status, surgical and pathological findings, hospital course, and follow-up findings were documented. If the operative note or the pathology report described the appendix as gangrenous or perforated, the case was considered to be late appendicitis. Group I patients had traditional indemnity insurance; group II patients were in our institution's managed care plan. One hundred two patients were identified (28 in group 1, 74 in group II). Late appendicits was found less often in the managed care group (21.6% v 42.9%; P < .01). This resulted in a lower rate of major complications (1.4% v 3.6%) and a lower overall complication rate (2.7% v 7.1%). Group II also had a shorter hospital stay (2.6 days v 4.5 days; (P < .01) and lower average hospital charges ($6,507 v $8,754 (P < .01). These results do not demonstrate any adverse affect on outcome for children with acute appendicitis who have a managed care plan. In fact, the incidence of late appendicitis among these patients was half of that of the indemnity-insured patients. The lower risk of late appendicitis resulted in a shorter length of stay and lower hospital charges. These results suggest that managed care programs can provide quality care along with a significant reduction in costs; no delay in appropriate surgical referral was demonstrated.

Acute Disease↗
PubMed1999

Neuroimmune appendicitis.

BACKGROUND: 15-25% of appendices removed from patients with suspected appendicitis appear normal on histological examination. The cause of pain in such patients is unknown. Since the content of neuropeptides seems to be altered in chronic inflammation, we investigated possible changes in peptidergic innervation for substance P (SP), vasoactive intestinal peptide (VIP), and growth-associated protein-43 (GAP-43). METHODS: Appendices classified as showing acute appendicitis, non-acute appendicitis (clinical signs of acute appendicitis, but histologically not inflamed), or normal were processed for SP, VIP, and GAP-43 immunocytochemistry. The density of SP immunostaining was assessed by digitised morphometry. FINDINGS: 31 appendix specimens were studied (16 acute, 15 non-acute). 16 specimens were used as controls. Expression of GAP-43 was increased in the non-acute appendices. We observed larger amounts of SP-immunoreactive and VIP-immunoreactive nerves in the mucosal layer of the appendix in patients with non-acute appendicitis than in controls and patients with acute appendicitis (mean % area SP-immunoreactive 0.0496 [SD 0.0113] non-acute, 0.0221 [0.0049] acute, 0.0229 [0.0068] controls). In addition, a close spatial relation between SP-immunoreactive and VIP-immunoreactive nerve fibres and lymphoid cells was detected in the outer zone of lymph follicles. INTERPRETATION: Neuroproliferation in the appendix, in association with an increase in neurotransmitters SP and VIP, may be involved in the pathophysiology of acute right abdominal pain in the absence of an acute inflammation of the appendix. Our data, together with increasing knowledge about the way in which the nervous system and immune cells interact, suggest that neuroimmune appendicitis is a distinct pathological entity.

Abdominal Pain↗
PubMedDate not supplied

Is the use of plain abdominal radiographs (PAR) a necessity for all patients with suspected acute appendicitis in emergency services?

PURPOSE: Almost all patients with suspected appendicitis have plain abdominal radiographies (PAR) at the emergency departments. The aims of this study are to evaluate the ability of PAR to diagnose suspected acute appendicitis in patients and to predict length of hospital stay (LOS). METHODS: Three blinded radiologists retrospectively and separately reviewed the preoperative PARs of all patients with suspected appendicitis, who underwent surgery in our hospital for 1 year period based on 8 radiologic criteria. The patients were divided into 3 groups [acute appendicitis (group 1), perforated appendicitis (group 2), and negative appendectomy (group 3)] according to their perioperative and pathological findings. The relationship between the presence/absence of the PAR findings and the diagnosis and LOS were analyzed. RESULTS: The study consisted of 162 patients (103 men, 63.6%). There were 96 (60.5%), 45 (27.8%), and 19 (11.7%) patients in groups 1, 2, and 3, respectively. Although there were more men in the study overall (p < 0.001), there were more women in groups 2 and 3 than group 1 (p = 0.004, p < 0.001, respectively). Group 2 had the longest LOS, and Group 3 had the shortest LOS (p < 0.001). The generalized air-fluid level was more commonly observed in group 2 patients (7 of 45) than in group 1 patients (2 of 98) (p < 0.05). The LOS was longer in group 3 when the sentinel loop was present on the PAR (n = 3) (p = 0.017), and in group 2 when the colon cutoff sign was positive (n = 3) on the PAR (p = 0.006). CONCLUSIONS: Our results suggest that PAR is rarely beneficial in the diagnosis of acute appendicitis and in the prediction of LOS. The PAR may not be a necessity for all patients with suspected acute appendicitis.

Adolescent↗
PubMed2005

[Appendicitis and pregnancy: 21 cases].

OBJECTIVE: Describe the epidemiological, diagnostic and therapeutic features of acute appendicitis in pregnant women. MATERIAL AND METHODS: Retrospective analysis of a series of 21 cases of appendicitis in pregnant women who underwent surgery between January 1997 and June 2001. RESULTS: The association of acute appendicitis with pregnancy was noted in 0.2% of the pregnant women. Ten patients were in the first trimester of pregnancy, ten in the second and one in the third. Abdominal pain was noted in all patients. The localization varied with gestational age. Abdominal ultrasound contributed to the diagnosis in twenty patients who underwent the examination. Diagnoses retained were: acute uncomplicated appendicitis (n=18), acute appendicitis with focal induration (n=1) and acute diffuse peritonitis (n=2). Appendectomy was performed in all cases. Intensive care, peritoneal cleaning and drainage were associated in cases with appendicitis. In cases with focal induration, medical treatment was followed by appendectomy performed after delivery. Tocolysis was instituted in all cases. Twelve pregnancies continued to delivery: one fetal death, one premature delivery and ten term deliveries of live infants. CONCLUSION: Pregnancy makes it difficult to confirm the diagnosis of appendicitis. Appendectomy should be performed in patients presenting a highly suggestive clinical and ultrasonographic picture, preferably by laparoscopy in order to avoid more severe complications which could be life-threatening for the mother or infant.

Acute Disease↗
PubMed1998

Schizophrenia among patients treated for rheumatoid arthritis and appendicitis.

The widely accepted negative association between schizophrenia and rheumatoid arthritis (RA) is based on the results of investigations which sought RA in large samples of schizophrenic patients. Using a discharge register, we examined the frequency of schizophrenia in a sample of 5626 RA patients. Appendicitis patients (n = 5330) were used as a comparison group. The cumulative incidence of hospital care with the diagnosis of schizophrenia during 8 years was higher in the RA group (0.64%) than in the appendicitis group (0.47%). Schizophrenia was significantly more common in the RA group than in the appendicitis group among the young. The age-adjusted prevalence of schizophrenia was 0.96% in the RA group and 0.51% in the appendicitis group. Because of this unexpected finding, we examined the incidence of RA and appendicitis among a birth cohort born in 1966. The frequencies of RA and appendicitis among schizophrenic cohort members (n = 76), cohort members with psychiatric diagnosis other than schizophrenia (n = 438), and members without psychiatric diagnosis (n = 10503) were similar. These findings do not support the negative association between schizophrenia and RA. Prolonged institutionalization per se may have been the protective factor against RA in the previous studies. The findings also raise the hypothesis that genes that predispose to schizophrenia provide protection from appendicitis, historically a common cause of mortality.

Adolescent↗
PubMed2004

Plasma D-lactic acid level: a useful marker to distinguish perforated from acute simple appendicitis.

Early diagnosis of perforated appendicitis is important for reducing morbidity rates. The aim of this study was to determine the value and utility of plasma D-lactic acid levels in identifying the type of appendicitis. In this clinical study, plasma D-lactic acid levels were assessed in 44 consecutive paediatric patients (23 with acute appendicitis, 21 with perforated appendicitis) before laparotomy. D-lactic acid levels were determined by an enzymatic spectrophotometric technique using a D-lactic acid dehydrogenase kit. Patients with perforated appendicitis had higher D-lactic acid levels (3.970 +/- 0.687 mg/dL) than patients in the control group (0.478 +/- 0.149 mg/dL) and patients with acute appendicitis (1.409 +/- 0.324 mg/dL; p < 0.05). For a plasma D-lactic acid level greater than 2.5 mg/dL, the sensitivity and specificity of the D-lactic acid assay were 96% and 87%, respectively. The positive predictive value was 87%, the negative predictive value was 96%, and the diagnostic value was 91%. These results suggest that the measurement of plasma D-lactic acid levels may be a useful adjunct to clinical and radiological findings in distinguishing perforated from acute non-perforated appendicitis in children.

Acute Disease↗
PubMed2000

Appendicitis in the elderly.

BACKGROUND: Acute appendicitis in the elderly (i.e. those over 60 years of age) is associated with high morbidity and mortality rates. The present retrospective study reviews 10 years ( 1986-1996) of experience and outcome in treating acute appendicitis in patients aged 60 or above. METHODS: One hundred and thirty patients with acute appendicitis were identified and their case notes reviewed. RESULTS: Acute appendicitis was diagnosed at admission in 84 patients (64.6%). The remaining patients were observed for a median duration of 9.4 h prior to diagnosis and treatment. Patients with an underlying perforated acute appendix had a significantly longer period of pain prior to admission (P = 0.029; Mann-Whitney U-test) but perforation per se was not associated with a significantly higher rate of morbidity and longer length of hospital stay. In contrast, the use of midline or paramedian incisions was associated with a higher wound infection rate (P=0.003; Pearson chi-squared test) and a longer hospital stay (P<0.001; Mann Whitney U-test). None of the patients were subsequently found to have an underlying colonic neoplasm. The overall morbidity rate was 28%. The mortality rate was 2.3% and all three patients who died had a severe comorbid medical condition prior to developing acute appendicitis. CONCLUSIONS: Acute appendicitis in the elderly is still associated with significant morbidity. But once acute appendicitis is diagnosed, then expedient surgery, appropriate use of perioperative antibiotics and a right lower quadrant incision can help to minimize the morbidity. Pre-existing severe comorbid medical condition(s) is a major contributory factor to mortality in these patients.

Abdominal Pain↗
PubMed2002

Utility of white cell count and ultrasound in the diagnosis of acute appendicitis.

BACKGROUND: Despite considerable advances in imaging, the diagnosis of acute appendicitis remains a clinical one. Nonetheless, knowledge of the characteristics of commonly used investigations for appendicitis may aid surgical decision-making. METHODS: The pathology, full blood counts and ultrasounds of 1013 patients who underwent appendicectomy were reviewed and subjected to statistical analysis in order to determine diagnostic characteristics of various white cell count and ultrasound results. RESULTS: Total white cell count was found to be higher among patients with complicated appendicitis than those with simple appendicitis or normal appendices. Ultrasound was found to be less accurate than white cell count and neutrophil count in the diagnosis of acute appendicitis by estimation of area under the receiver operator characteristic curve. CONCLUSION: Knowledge of the meaning of various white cell count values may be invaluable in clinical decision-making with regard to the diagnosis of acute appendicitis. Ultrasound is of limited utility in the diagnosis of appendicitis and should only be used in selected clinical situations.

Acute Disease↗
PubMed2004

Granulomatous appendicitis and the appendix in idiopathic inflammatory bowel disease.

Granulomatous appendicitis is a rare condition, accounting for less than 2% of all cases of appendicitis. The initial belief that it represented a manifestation of Crohn's disease is incorrect in the great majority of cases, as only 5-10% of patients with granulomatous appendicitis develop Crohn's disease elsewhere in their gastrointestinal tract. The remaining etiologies are diverse. Unusual causes include sarcoidosis, foreign body reaction, and infection by mycobacteria, fungi, or parasites. These conditions combined explain less than 10% of cases. More recently, two etiologies have been recognized that potentially account for most of the previous "idiopathic" cases of granulomatous appendicitis. The first is infection by pathogenic Yersinia species, now demonstrated in approximately 25% of cases. The second cause may be the most common of all, namely subacute/recurrent appendicitis with interval appendectomy. This condition likely produces a granulomatous reaction in relation to a protracted secondary inflammatory response to appendicitis and temporizing measures to delay appendectomy, such as antibiotic therapy. Thus, granulomatous appendicitis only rarely represents a manifestation of Crohn's disease. Rather, the overwhelming majority of patients with this condition are cured by appendectomy alone. The appendix, however, can be involved by idiopathic inflammatory bowel disease, both Crohn's disease and ulcerative colitis. It can be involved by ulcerative colitis in patients with distal colonic involvement and sparing of the intervening colonic segment, a phenomenon known as the appendiceal "skip lesion" or "cecal patch" and this pattern of involvement does not necessarily indicate Crohn's disease. Interestingly, appendectomy has been shown to provide some protection against developing inflammatory bowel disease and in reducing its severity if performed before the onset of disease.

Appendectomy↗
PubMed2001

The impact of ultrasound examinations on the management of children with suspected appendicitis: a 3-year analysis.

BACKGROUND/PURPOSE: The aim of this study was to evaluate the usefulness of ultrasonography in the routine management of children with suspected appendicitis in a children's hospital. METHODS: Data from surgical, radiologic, and pathologic databases were cross referenced retrospectively to allow for review of all children undergoing appendectomy and all children undergoing an ultrasound scan to rule out appendicitis in the 3-year period August 1, 1996 to July 31, 1999. RESULTS: Pathology reports were available for 1,007 of 1,032 patients undergoing appendectomy. Eighty-four percent had acute appendicitis (26% of these were perforated). Fifty-eight percent of all children undergoing appendectomy had at least 1 preoperative ultrasound scan. Eighty-six percent of those having ultrasound scans had acute appendicitis compared with 82% of those who did not have an ultrasound scan (P <.05 chi(2) Test). During the same period, 2,056 ultrasound examinations were performed by staff radiologists who were available 24 hours a day to rule out appendicitis. Ultrasonography in this setting had a sensitivity of 89%, specificity of 95%, positive predictive value of 86%, and a negative predictive value of 96% (true-positives, n = 496; false-positive, n = 81; true-negative, n = 1,417; false-negative, n = 62). An alternate ultrasound diagnosis was offered in 157 children. CONCLUSIONS: Ultrasound scan improves diagnostic accuracy in children with suspected appendicitis. The high negative predictive value of ultrasound scan, especially when used repeatedly, may reduce the need for admission to hospital for clinical observation to rule out appendicitis.

Adolescent↗
PubMed2003

Appendicitis in children: a ten-year update of therapeutic recommendations.

BACKGROUND/PURPOSE: In 1990, the authors reported excellent outcomes using a standard protocol to treat pediatric appendicitis. This protocol has been simplified further and a large retrospective review was conducted to assess current outcomes. METHODS: All patients treated for presumed appendicitis between April 1997 and December 1999 were reviewed. All patients received preoperative gentamicin and clindamycin. Patients with complicated appendicitis received postoperative ampicillin, gentamicin, and clindamycin or metronidazole. All wounds were closed primarily without drains. Patients with complicated appendicitis were discharged when their ileus resolved, they remained afebrile for 24 hours, and had a normal leukocyte count. RESULTS: A total of 648 patients were reviewed. A total of 9.4% of appendices were pathologically normal, 55.6% were simple acute, 15.7% were gangrenous, and 19.3% were perforated. Hospital stay was 2.21 +/- 2.04 days for normal, 1.39 +/-.89 for simple acute, 2.97 +/- 1.25 for gangrenous, and 6.31 +/- 3.51 days for perforated appendices. There were no wound infections in patients with normal or simple acute appendices. Two minor intraabdominal infections (0.56%) occurred in patients with simple appendicitis. Patients with complicated appendicitis (gangrenous or perforated) had wound infection and intraabdominal infection rates of 2.6% and 4.4%, respectively. CONCLUSIONS: The authors' current protocol results in reasonable hospital stays and good outcomes. It serves as an evidence-based standard of care for the treatment of pediatric appendicitis.

Abdominal Abscess↗