Non-operative treatment strategy for appendiceal abscess in children under 3 years old: a retrospective observational study

Abstract

BackgroundThere are few studies on appendiceal abscess with appendicolith in children under 3 years old. This study aims to explore the success rate of non-surgical treatment of appendiceal abscess and assess the potential influence of an appendicolith on non-surgical treatment outcomes in children under 3 years old.MethodsThe clinical data of children under 3 years old who were diagnosed with appendiceal abscess at the Wuhan Children's Hospital, China, from February 2013 to May 2020 were collected. According to the findings of ultrasonography and CT imaging, they were divided into two groups, namely, the appendicolith group and the non-appendicolith group.ResultsA total of 94 children with appendiceal abscess were identified, meeting the specified study criteria, and categorized into two groups, namely, the appendicolith group (n = 51, 54.3%) and the non-appendicolith group (n = 43, 45.7%). Non-surgical treatment was unsuccessful in six out of the 94 children, yielding an overall success rate of 93.6% for non-surgical management of appendiceal abscess in children under 3 years old. The success rate for non-surgical treatment in the appendicolith subgroup was 90.2%, whereas that for the non-appendicolith subgroup was 97.7%. No statistically significant distinction was observed between the two groups (P = 0.292). Likewise, there were no significant differences in gender, age, duration of symptoms, fever, vomiting, diarrhea, rebound pain, white blood cell count, C-reactive protein level, and abscess cross-sectional area between the appendicolith group and the non-appendicolith group. However, there is a statistical difference in tenderness in the right lower abdomen.ConclusionNon-surgical treatment of appendiceal abscess has a high success rate and can be considered an effective treatment strategy. In pediatric patients under 3 years old without evidence of complete intestinal obstruction or diffuse peritonitis, non-surgical treatment may be considered for appendiceal abscess.

Case Report - A Safe Laparoscopic Technique for Complicated Appendicitis

“…Two factors contributed to changing the treatment of appendicitis: the advent of minimally invasive technology and more nuanced understanding of pathogenesis. Whereas formerly a single mechanism was postulated for both uncomplicated and complicated appendicitis, now the etiology of uncomplicated appendicitis is believed to be different than that of complicated appendicitis [11,12,13] The appendix is no longer considered a vestigial organ. It is believed to play a role in the development of gastrointestinal immunity, especially extrathymically derived T and B lymphocytes [13].…”

“…Uncomplicated appendicitis is attributed to dysfunction in the interaction of host immunity and gastrointestinal pathogens; hence, the e cacy of antibiotics in some instances. [1,11,12].…”