Current management of appendicitis

Morrow, Stephen E.; Newman, Kurt D.

doi:10.1053/j.sempedsurg.2006.10.005

Cited by 128 publications

(87 citation statements)

References 71 publications

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“…Nonoperative management for perforated appendicitis with abscess followed by interval appendectomy was described more than 25 years ago [1], and it is practiced by many pediatric surgeons [2]. In a patient with an abscess on presentation, percutaneous drainage is an additional modality to nonoperative management [3]. The safety and efficacy of interval appendectomy have been described in a few studies [4,5].…”

Section: Discussionmentioning

confidence: 99%

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Keckler

Tsao

Sharp

et al. 2008

Journal of Pediatric Surgery

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Objective-Given the perceived technical demands of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess, initial percutaneous drainage has become an attractive option in this patient population. This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon. However, the medical burden on the patient and on the quality of patient outcomes has not been described in the literature. Therefore, we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospective trial.Methods-After institutional review board approval, a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006. Continuous variables are listed with standard deviation.Results-There were 52 patients with a mean age of 9.0 ± 3.9 years and weight of 34.4 ± 18.8 kg. The mean duration of symptoms at presentation was 8.4 ± 7.6 days. Percutaneous aspiration only was performed in 2 patients. The mean volume of fluid on initial aspiration/drain placement was 76.3 ± 81.1 mL. The mean time to appendectomy was 61.9 ± 25.2 days. The laparoscopic approach was used in 49 patients (94.2%), of which one was converted to an open operation. The mean length of hospitalization after interval appendectomy was 1.4 ± 1.4 days. A recurrent abscess developed in 17.3% of the patients. Six patients (11.5%) required another drainage procedure. The mean total charge to the patients was $40,414.02. There were 4 significant drain complications (ileal perforation, colon perforation, bladder perforation, and buttock/thigh necrotizing abscess).The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy.Conclusions-The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach. However, this management poses complication risks and uses considerable resources. Therefore, this strategy should be compared with early operation in a prospective trial.

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Section: Discussionmentioning

confidence: 99%

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Keckler

Tsao

Sharp

et al. 2008

Journal of Pediatric Surgery

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“…4 Perforated appendicitis is a complication caused by appendicitis resulting local or general peritonitis. 1,2,5 The incidence of perforated appendicitis in children is around 30-40%, whereas in preschool children range from 60 to 65%.The incidence of perforated appendicitisin children aged less than 2 year is lower (2%), however the risk of getting perforated is higher (95%). 3 Multiethnic study in 53,555 appendicitis cases in US children showed that 63.5% perforated appendicitis and 36.5% simple appendicitis.…”

Section: Introductionmentioning

confidence: 99%

“…1 The risk of getting appendicitis in children aged 1 to 14 years is 7%. In United States, more than 70,000 cases of appendicitisa year or about 1 child in every 1000 children were reported.…”

Section: Introductionmentioning

confidence: 99%

“…If the perforated appendicitis getting worse, severe complications such as sepsis, multisystem organ failure, and death will occur. 1 Perforated appendicitis should be operated immediately along with the administration of wide-spectrum antibiotics. 8,9 Antibiotics regimen should be appropriate and effective against the gastrointestinal tract microorganisms.…”

Section: Introductionmentioning

confidence: 99%

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Microbiological profile and antimicrobial susceptibility in children with perforated appendicitis at Dr. Sardjito General Hospital, Yogyakarta

Dwihantoro¹,

Rochadi

2016

JMedScie

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Acute appendicitis is the most common surgical cause of acute abdominal pain in children. Perforated appendicitis is the major complication of acute appendicitis with incidence in children of 30-40%. Perforated appendicitis should be operated immediately along with the administration of broad-spectrum antibiotics. The aim of this study isto analyze the microbiological profile and determine the antimicrobial susceptibility in children with perforated appendicitis at Dr. Sardjito General Hospital, Yogyakarta, Indonesia.We analyzed the pus from the perforated appendicitis patients who underwent surgery at Dr. SardjitoGeneral Hospital from January 2005 to September 2009. Escherichia coli (43%) was the most common aerobic bacteria found in children with perforated appendicitis, followed by Pseudomonas aeruginosa (26%), Klebsiellapneumonia (11%), Streptococcus (11%), and Proteus mirabilis (3%).The most sensitive antibiotics were imipenem, phosphomycin, amikacin and netilmicin, followed by the 4 th and the 3 rd generation of cephalosporin, amoxicillin, ampicillin, and trimethoprim/sulfamethoxazole. In addition, there was no statistically significant difference in terms of resistant and sensitivity between the 4 th generation cephalosporin compared to phosphomycin, netilmicin, or imipenem (p > 0.05). In conclusion, the most common bacteria found in perforated appendicitis in Dr. Sardjito General Hospital is E.coli. The administration of the 4 th generation of cephalosporin might be appropriate for the children with perforated appendicitis. ABSTRAKAppendisitis adalah penyebab terbanyak akut abdomen yang memerlukan pembedahan pada anak. Komplikasi apendisitis adalah perforasi dan insidensinya pada anak 30-40%. Terapi apendisitis perforasi yaitu operasi segera dengan pemberian antibiotica berspektrum luas. Tujuan penelitian adalah untuk menganalisis profil mikrobiologi apensitis perforasi dan menentukan sensitivitas antibiotic pada anak dengan apendisitis perforasi di RumahSakit Umum Pusat Dr. Sardjito, Yogyakarta, Indonesia. Subjek penelitian adalah bakteri aerob hasil isolasi pus cavum peritoneum/intraperitoneal pasien apendisitis perforasi anak yang dioperasi di RSUP Dr. Sardjito Yogyakarta Januari 2005 -September 2009. Ditemukan bakteri aerob terbanyak pada pasien apendisitis perforasi anak adalah E.coli, kemudian P. aeruginosa, Kl. pneumonia, Streptococcus, dan P. mirabilis. Antibiotika paling sensitif; imipenem, fosfomisin, amikasin, dan netilmisin; diikuti sefalosporin generasi 4 dan 3, amoksisilin, ampisilin, trimetoprim/sulfametoksazol. Tidak ada perbedaan secara nyata J Med Sci, Volume 48, No. 1, 2016 January: 35-44 36 dalam hal resistensi dan sensitivitas antara sefalosporin generasi ke-4 dibandingkan dengan fosfomycin, netilmisin, atau imipenem (p> 0,05). Kesimpulannya, bakteri yang paling sering umum pada apendisitis perforasi anak di RSUP Dr. Sardito, Yogyakarta adalah E. coli. Terapi dengan antibiotic cephalosporin generasi ke-4 tepat untuk anak-anak dengan apendisitis perforasi.

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“…Complicated appendicitis involves a larger proportion of pediatric appendicitis cases relative to adult cases. The postoperative morbidity rate is also higher for pediatric than adult patients due to distinct characteristics such as difficulty in diagnosing children, and the rapid progress of infectious processes within a smaller abdominal cavity [6]. Therefore, adequate judgment related to the appropriate management of pediatric complicated appendicitis is a substantial issue.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Surgical Infection and Readmission Rates after Laparoscopy in Pediatric Complicated Appendicitis

Boo

Lee

et al. 2014

J Korean Assoc Pediatr Surg

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Purpose: Laparoscopic appendectomy (LA) has become a gold standard for children even in complicated appendicitis. The purpose of this study was to compare the postoperative surgical site infection rates between laparoscopic and open appendectomy (OA) group in pediatric complicated appendicitis. Methods: A total of 1,158 pediatric patients (age ≤15 years) underwent operation for appendicitis over a period of 8 years. Among these patients, 274 patients (23.7%) were diagnosed with complicated appendicitis by radiologic, operative and pathologic findings, and their clinical outcomes were retrospectively analyzed. Results: Of the 274 patients with complicated appendicitis, 108 patients underwent LA and 166 patients underwent OA. Patients in the LA group returned to oral intake earlier (1.9 days vs. 2.7 days; p＜0.01) and had a shorter hospital stay (5.0 days vs. 6.3 days; p＜0.01). However, rate of postoperative intra-abdominal infection (organ/space surgical site infection) was higher in the LA group (LA 15/108 [13.9%] Conclusion:The minimally invasive laparoscopic technique has more advantages compared to the open procedure in terms of hospital stay and early recovery. However, intra-abdominal infection and readmission rates were higher in the laparoscopy group. Further studies should be performed to evaluate high rate of organ/space surgical infection rate of laparoscopic procedure in pediatric complicated appendicitis.

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Current management of appendicitis

Cited by 128 publications

References 71 publications

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess

Microbiological profile and antimicrobial susceptibility in children with perforated appendicitis at Dr. Sardjito General Hospital, Yogyakarta

Comparison of Surgical Infection and Readmission Rates after Laparoscopy in Pediatric Complicated Appendicitis

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