Conservative management of early uncomplicated appendicitis in children

Maini, Sunil Kumar; Jain, Neeraj; Jain, Manjari Goel; Khobragade, Vicky

doi:10.18203/2349-2902.isj20170855

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…Eight studies provided comparative data on the length of hospital stay (LOS) [22][23][24][25][28][29][30][31][32]. Three of these studies revealed that the NOM group had a longer LOS than the appendectomy group [22,28,31].…”

Section: Length Of Hospital Staymentioning

confidence: 99%

A Systematic Review Comparing Nonoperative Management to Appendectomy for Uncomplicated Appendicitis in Children

Mosuka¹,

Thilakarathne²,

Mansuri³

et al. 2021

Cureus

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More than a century after its introduction, appendectomy has remained the gold standard treatment for acute appendicitis. In adults with acute uncomplicated appendicitis, nonoperative management (NOM) has been shown to be a viable treatment option. To date, there has been relatively limited data on the nonoperative management of acute appendicitis in the pediatric population. The primary objective of this study was to systematically review the available literature in the pediatric population and compare the efficacy and recurrence between initial nonoperative treatment strategy and appendectomy in children with uncomplicated appendicitis. In July 2021, we conducted systematic searches of the PubMed and Google Scholar databases. We only included full-text comparative original studies published within the last decade, and we excluded articles that solely examined NOM without comparing it to appendectomy. Two writers worked independently on the data collection and analysis. It was found that NOM had a high initial success rate and a low rate of recurrent appendicitis. After months of follow-up, the vast majority of patients with uncomplicated acute appendicitis who received initial nonoperative treatment did not require surgical intervention. Furthermore, the rate of complication was comparable in both treatment groups, and NOM did not appear to be associated with an increased risk of complications. The most significant drawback stemmed from the fact that the included articles in this study had a wide range of study designs and inclusion criteria. According to current evidence, NOM is feasible and cost-effective. Antibiotic therapy can be given safely in a small subset of individuals with uncomplicated appendicitis. To optimize outcomes, physicians should evaluate the clinical presentation and the patient's desire when selecting those to be managed nonoperatively. Again, more research, preferably large randomized trials, is required to compare the longterm clinical efficacy of NOM with appendicectomy. Finally, additional research is required to establish the characteristics of patients who are the best candidates for nonoperative treatment.

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Section: Length Of Hospital Staymentioning

confidence: 99%

A Systematic Review Comparing Nonoperative Management to Appendectomy for Uncomplicated Appendicitis in Children

Mosuka¹,

Thilakarathne²,

Mansuri³

et al. 2021

Cureus

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Acute Abdomen in Pediatric Patients With Lassa Fever: Prevalence and Response to Nonoperative Management

Akpede

Adetunji

Udefiagbon

et al. 2018

Journal of the Pediatric Infectious Diseases Society

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Few reports on the prevalence of acute abdomen (AAbd) in pediatric patients with Lassa fever (LF) are available, and no firm policy on its management exists. Here, we report on its prevalence in and the response to treatment among a cohort of children with confirmed LF. Six (10.3%) of 58 children with LF had AAbd, whereas 6 (2.8%) of 215 children with AAbd had LF. Nonoperative treatment was successful in 5 of the 6 children with both AAbd and LF. We conclude that AAbd is not uncommon in pediatric patients with LF, and it could be responsive to nonoperative treatment. Testing for LF in all children with febrile AAbd might be justified in areas in which LF is endemic.

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Feasibility of nonoperative treatment of acute appendicitis in children: a prospective cohort study

Perveen,

Akhtar,

Ali

et al. 2023

Singapore Medical Journal

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Introduction: The management of acute appendicitis is a matter of debate even in contemporary era. Non-operative management is proposed as a valid treatment option for acute appendicitis in children. Methods: A prospective cohort study was conducted from April 2020 to September 2021 at the National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan, in children aged ≤ 12 years who were suspected of having acute appendicitis. Children with diffuse peritonitis and complex mass on ultrasonography were excluded. All children were kept nil per oral and started on intravenous fluid hydration and antibiotics. Statistical analyses were performed using IBM SPSS version 20. Chi-square test and Fisher’s exact test were applied to determine the statistical significance. Results: A total of 190 patients were admitted with a diagnosis of acute appendicitis. Thirty-two children with advanced disease underwent surgery. The remaining 158 patients were managed with nonoperative treatment. In 138 (87.3%) patients, resolution of symptoms occurred. Twenty (12.7%) patients underwent operation during the same admission (non-responders). Thirteen (9.4%) patients had recurrence of symptoms and underwent appendectomy. A total of 33 (20.9%) patients had appendectomy either at the primary admission or after discharge. Non-operative treatment was more likely to be successful in patients with symptoms of ≤ 24 h duration (P = 0.02), total leucocyte count of <12 × 109 cells/L (P = 0.005) and smaller size of the appendix on ultrasound (P = 0.001). Conclusion: Among children with uncomplicated acute appendicitis, a non-operative approach resulted in resolution of symptoms in 87.3% of patients at the initial admission. Failure of non-operative treatment and recurrence of disease after discharge from the hospital occurred in 9.4% of patients after successful initial treatment. Thus, the overall success rate at a mean follow-up of 3 months was about 78%.

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Conservative management of early uncomplicated appendicitis in children

Cited by 3 publications

References 11 publications

A Systematic Review Comparing Nonoperative Management to Appendectomy for Uncomplicated Appendicitis in Children

A Systematic Review Comparing Nonoperative Management to Appendectomy for Uncomplicated Appendicitis in Children

Acute Abdomen in Pediatric Patients With Lassa Fever: Prevalence and Response to Nonoperative Management

Feasibility of nonoperative treatment of acute appendicitis in children: a prospective cohort study

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