Evaluation of antibiotic and surgical treatment results in children with acute appendicitis

Abeş, Musa; Apaydın, Hasan Öğünç; Şirik, Mehmet; Pehlivanoğlu, Burçin; Üçkardeş, Fatih

doi:10.5222/jtaps.2019.17363

Cited by 1 publication

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“…Currently, appendectomy is still the gold standard treatment for the management of acute appendicitis. On the other hand, there are many studies evaluating the therapeutic effectiveness of antibiotic therapy for the treatment of uncomplicated acute appendicitis, with conflicting results in terms of treatment success [ 3 – 6 , 12 , 13 ]. While some studies state that antibiotic therapy is safe and effective and should be regarded as an initial therapeutic option in uncomplicated appendicitis [ 6 , 12 , 13 ], others suggest that nonoperative treatment may not be considered the first-line treatment for all cases of uncomplicated appendicitis [ 4 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, there are many studies evaluating the therapeutic effectiveness of antibiotic therapy for the treatment of uncomplicated acute appendicitis, with conflicting results in terms of treatment success [ 3 – 6 , 12 , 13 ]. While some studies state that antibiotic therapy is safe and effective and should be regarded as an initial therapeutic option in uncomplicated appendicitis [ 6 , 12 , 13 ], others suggest that nonoperative treatment may not be considered the first-line treatment for all cases of uncomplicated appendicitis [ 4 , 14 ]. However, there are differences across these studies including variations in the definition of uncomplicated appendicitis, and study inclusion and exclusion criteria, which may be a source of potential bias.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Lowe et al [ 10 ] involving 60 pediatric patients diagnosed with appendicitis, the prevalence of appendicoliths identified on CT without contrast material was 65% (39/60). In Abeş et al’s study [ 13 ] comparing the outcomes of antibiotic therapy with those of surgical treatment in 205 pediatric patients diagnosed with acute appendicitis, the overall prevalence of appendicoliths was 29% versus 46% (39/85) in patients undergoing surgery. In that study, the prevalence of appendicoliths was assessed using ultrasound (US) or CT imaging and compared to our study, a relatively higher rate of appendicoliths was found in surgically treated patients.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of appendicolith in children with acute appendicitis and its correlation with disease severity

Oktay¹

2023

North Clin Istanbul

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OBJECTIVE Appendicitis typically develops secondary to obstruction of appendiceal lumen and one of the causes of obstruction is appendicolith. Appendicolith has become a relevant issue due to heightened interest in the treatment of uncomplicated appendicitis with antibiotics. This study aimed to determine the prevalence of appendicolith in pediatric patients with appendicitis and to investigate the association between the presence of appendicoliths and radiological disease severity. METHODS Patients under the age of 18 diagnosed with appendicitis between March 2021 and April 2022 and had available preoperative computed tomography (CT) images were identified retrospectively. The presence of an appendicolith and if present, its longest diameter in the axial plane, its visibility on direct radiographs, appendiceal diameter, degree of inflammation, and the presence of perforation were evaluated. Radiological severity of inflammation was rated on a 3-point scale. RESULTS CT scans were available in 77 (32.1%) of 240 patients with histopathologically confirmed diagnosis of acute appendicitis. 39% (n=30) of the patients were girls and the median age was 13 years. The prevalence of appendicoliths detected on CT scans was 32.5% (n=25) and the median size of appendicoliths was 6 mm. In only 1 patient, appendicolith was detected by direct radiography. The median appendiceal diameter was significantly greater in the group with appendicoliths (10 mm vs. 8 mm; p=0.001). A moderate correlation was found between appendicolith size and appendiceal diameter (r=0.407, p=0.043). Perforation was present in 10.4% (n=8) of the patients with appendicitis and 25% (n=2) of them had appendicoliths. The presence of appendicoliths was not significantly associated with the occurrence of perforation (p=0.485). Periappendiceal inflammation scores were 1.52±0.74 in the group with appendicoliths and 1.42±0.63 in the group without appendicoliths (p=0.591). CONCLUSION The prevalence of CT-detected appendicoliths was 32.5% in pediatric patients with appendicitis. Patients with appendicoliths showed higher inflammation scores and greater appendiceal diameter than those without appendicoliths. These factors may be associated with poor outcomes in patients with appendicoliths treated with antibiotics. Therefore, knowledge of the prevalence of appendicoliths and questioning their presence may guide clinicians when deciding on the suitability of nonoperative treatment in a patient diagnosed with uncomplicated acute appendicitis.

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