Our Summary

This research paper aimed to understand what factors might lead to failure in non-surgical treatments for children with perforated appendicitis, and compare these factors to those associated with immediate removal of the appendix. The study was approved by an ethical review board and data was collected from September 2016 to August 2017.

Children aged 1 to 18 years who underwent completed appendix removals and had confirmed perforations were included in the study. They were treated based on the preference of their clinician. Non-surgical treatments were considered to have failed if the child’s symptoms did not improve or returned before the planned interval.

The study found that of 201 suspected cases of perforated appendicitis, 176 were included in the final analysis. 101 of these children (57%) underwent immediate appendectomy, while 75 (43%) were treated non-surgically.

Out of those treated non-surgically, 24 (32%) cases were unsuccessful; 6 of these failures happened in the hospital, while 18 occurred after the child was discharged. In 51 cases (68%), non-surgical treatment was successful.

The study found that younger children were more likely to experience failure with non-surgical treatment. Treatment success was also associated with a longer period between the start of pain and the beginning of treatment (2.75 days or more) and a lower white blood cell count at the time of presentation.

In comparison to immediate appendectomy, non-surgical treatments were associated with more complications. The authors concluded that younger children, who experience rapid perforation and have a lower white blood cell count, would benefit more from immediate removal of the appendix.

FAQs

  1. What factors are associated with nonoperative treatment failure in pediatric perforated appendicitis according to the study?
  2. How does the timing of pain onset affect the success or failure of nonoperative treatment for pediatric perforated appendicitis?
  3. What are the outcomes for younger children with perforated appendicitis who receive nonoperative treatment versus immediate appendectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about appendectomy is to seek immediate treatment if experiencing symptoms of appendicitis, such as abdominal pain, fever, and nausea, as delaying treatment can lead to complications like perforation. Additionally, younger children may be at higher risk for nonoperative treatment failure, so it is important to closely monitor symptoms and follow up with healthcare providers as needed.

Suitable For

Patients who are typically recommended for appendectomy include those with suspected or confirmed perforated appendicitis, particularly in pediatric populations. Younger children may benefit from immediate appendectomy as they are more likely to fail nonoperative treatment and have a higher risk of perforation. Other factors associated with nonoperative treatment failure include a shorter time from pain onset to treatment initiation and lower white blood cell count at presentation. Overall, appendectomy is recommended for patients with perforated appendicitis to prevent complications and improve outcomes.

Timeline

Before appendectomy:

  • Patient experiences abdominal pain, often starting in the middle of the abdomen and then moving to the lower right side
  • Patient may also experience loss of appetite, nausea, vomiting, and possibly a low-grade fever
  • Patient may undergo diagnostic tests such as physical examination, blood tests, and imaging studies (such as ultrasound or CT scan) to confirm diagnosis of appendicitis
  • Once diagnosis is confirmed, patient may be given antibiotics to reduce the risk of infection before surgery

After appendectomy:

  • Patient undergoes surgery to remove the inflamed appendix, either through open surgery or laparoscopic surgery
  • Recovery time varies but typically patients stay in the hospital for 1-2 days after surgery
  • Patient may experience pain, swelling, and bruising at the incision site
  • Patient is typically advised to rest and avoid strenuous activities for a few weeks post-surgery
  • Follow-up appointments may be scheduled to monitor healing and ensure there are no complications from the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about appendectomy include:

  1. What are the risks and benefits of immediate appendectomy versus nonoperative treatment for perforated appendicitis in children?
  2. What factors determine whether nonoperative treatment is likely to be successful or if surgery is necessary?
  3. How quickly should treatment be initiated after the onset of symptoms in order to maximize the chances of success with nonoperative treatment?
  4. What are the potential complications or side effects of both immediate appendectomy and nonoperative treatment?
  5. How will the decision between immediate appendectomy and nonoperative treatment impact the child’s recovery and long-term health?
  6. Are there any alternative treatment options available for pediatric perforated appendicitis?
  7. How will the child’s age and white blood cell count at presentation affect the likelihood of success with nonoperative treatment?
  8. What follow-up care will be necessary after either immediate appendectomy or nonoperative treatment?
  9. How can we minimize the risk of treatment failure and complications in pediatric perforated appendicitis?
  10. Are there any specific warning signs or symptoms that should prompt immediate medical attention after either immediate appendectomy or nonoperative treatment?

Reference

Authors: Munoz A, Hazboun R, Vannix I, Pepper V, Crane T, Tagge E, Moores D, Baerg J. Journal: J Pediatr Surg. 2019 Sep;54(9):1809-1814. doi: 10.1016/j.jpedsurg.2018.10.107. Epub 2018 Dec 15. PMID: 30638663