High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

Mahida, Justin B.; Lodwick, Daniel L.; Nacion, Kristine M.; Sulkowski, Jason P.; Leonhart, Karen; Cooper, Jennifer N.; Ambeba, Erica J.; Deans, Katherine J.; Minneci, Peter C.

doi:10.1016/j.jpedsurg.2016.02.056

Cited by 88 publications

(74 citation statements)

References 21 publications

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“…In adult patients Vons et al 21 recently reported that faecoliths were associated with complicated (perforated) appendicitis as well as with the failure of conservative management. Furthermore, a recent prospective trial on conservative management in children with appendicoliths was halted owing to an unacceptably high failure rate of 60% 22. Our results are in line with these findings.…”

Section: Discussionsupporting

confidence: 88%

Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis

Kessler¹,

Mosbahi²,

Walker³

et al. 2017

Arch Dis Child

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Section: Discussionsupporting

confidence: 88%

Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis

Kessler¹,

Mosbahi²,

Walker³

et al. 2017

Arch Dis Child

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“…One patient was therefore operated on immediately and the other two patients underwent appendectomy within 8 weeks because of recurrent symptoms. This is in line with results from a cohort study investigating NOT in children with uncomplicated appendicitis and a faecalith on pre-operative imaging [26]. This study was discontinued early after treating five children non-operatively since three of these children suffered a recurrence at a median follow-up of 4.7 months.…”

Section: Discussionsupporting

confidence: 72%

Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study

et al. 2018

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Non-operative treatment of uncomplicated appendicitis in children is gaining ground. Pending definitive evidence regarding its effectiveness, there is a call to evaluate clinical recovery after non-operative treatment. In this study, we analyzed data collected during initial admission of a multicenter prospective cohort in which children, 7–17 year, were treated non-operatively for uncomplicated appendicitis. During admission clinical parameters (pain and gastro-intestinal symptoms), inflammation parameters and sequential abdominal ultrasound were recorded. In total, 45 children were included, 42(93%) were discharged without the need for appendectomy; median [IQR] pain scores on admission were 5 [4–7], decreasing to 2 [0–3] after 1 day of treatment. Initially, 28/42 (67%) reported nausea and 19/42 (45%) vomiting; after 1 day, this was 3/42 (7%) and 1/42 (2%), respectively. White blood cell count declined from a median [IQR] of 12.9 [10.7–16.7] 10E9/L on admission to 7.0 [5.8–9.9] 10E9/L on day 1. Median [IQR] C-reactive protein levels increased from 27.5 [9–69] mg/L on admission to 48 [22–80] mg/L on day 1, declining to 21.5 [11–42] mg/L on day 2. Follow-up ultrasound showed no signs of complicated appendicitis in any of the patients.Conclusion: Clinical symptoms resolved in most children after 1 day of non-operative treatment. This suggests that non-operative treatment is a viable alternative to appendectomy regarding clinical recovery.Trail registration: NCT01356641 What is Known: • Non-operative treatment of uncomplicated appendicitis in children is safe and its use around the world is gaining ground, however high quality evidence from adequately designed randomized trials is still lacking.• Concerns have been raised regarding the potentially prolonged clinical recovery associated with non-operative treatment. What is New: • Most clinical symptoms resolve after 1 day of non-operative treatment in the majority of children.Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3277-9) contains supplementary material, which is available to authorized users.

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“…In this regard, prediction of negative outcome is important in the selection of the NOM: The presence of an appendicolith is correlated to an unacceptably high failure rate in paediatric patients treated with NOM. This is likely owing to a high proportion of these children having more advanced (gangrenous or perforated) appendicitis despite a pre‐operative evaluation suggesting uncomplicated acute appendicitis …”

Section: Multiple Choice Questionsmentioning

confidence: 99%

Still toddler: A clinical clue for acute appendicitis

Cozzi

Galdo

Germani

et al. 2018

J Paediatrics Child Health

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High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

Cited by 88 publications

References 21 publications

Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis

Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis

Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study

Still toddler: A clinical clue for acute appendicitis

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