Non-Operative management of acute appendicitis in children

Abstract

Purpose: Most studies addressing non-operative management for acute appendicitis have focused on adults, and there are limited data available for children. We aimed to evaluate the results of successful non-operative management in children with acute uncomplicated appendicitis with our “additional criteria” and find which factors could be affecting the success rate and which cases could be candidates for non-operative management. Materials and methods: A total of 26 patients who were diagnosed with acute uncomplicated appendicitis and received non-operative management were re-evaluated retrospectively. Defining uncomplicated appendicitis was based on the duration of symptoms (<24 hours), clinical history, and radiologic findings. The radiologic evaluation was based on ultrasonography and computed tomography. The patients received an intravenous antibiotic combination (sulbactam/ampicillin, gentamicin, clindamycin) for five days at the hospital; the treatment was completed after 10 days with an oral antibiotic combination (amoxicillin/clavulanate, metronidazole). The cases have a follow-up period of up to two years. Results: The mean patient age and follow-up time were 10.42±3.65 years and 30.15±5 months, respectively. The mean leukocyte count, C-reactive protein (CRP), and appendix diameter values were 15.82±5.4×109/L, 20.38±33.4mg/dL, and 7.87±1.4 mm on admission. None of the patients had an early failure, complication, or adverse event. Recurrent appendicitis occurred in only one case (4%) that was treated by laparoscopic appendectomy during the follow-up. Conclusion: Non-operative management for acute uncomplicated appendicitis in children regarding long-term outcomes with our criteria was satisfactory and initial success rates were excellent.