J Korean Surg Soc.  2010 Apr;78(4):242-248. 10.4174/jkss.2010.78.4.242.

Optimal Time for Appendectomy in Perforated Appendicitis of Children

• Noh KT
• Chung SS
• Choi KJ

• KMID: 1750737
• DOI: http://doi.org/10.4174/jkss.2010.78.4.242

Abstract

PURPOSE
It is controversial to treat complicated appendicitis in pediatric patients on several points, especially optimal time for appendectomy. The purpose of this study is to determine optimal time for operation in perforated appendicitis in pediatric patients.
METHODS
Children with perforated appendicitis under the age of 14 underwent appendectomy between January 2006 and December 2008 at Ewha Womans University Mokdong Hospital were analyzed retrospectively according to factors which may affect the postoperative hospital course such as complications, time of beginning of diet, and length of hospital stay.
RESULTS
During the study period, 357 patients with acute appendicitis underwent appendectomy and 118 patients were diagnosed with perforated appendicitis. Comparing symptom durations between more than 48 hours and less, the former induced significantly higher postoperative complication rates. Body temperature above 37.5degrees C at admission affected significantly higher complication rates and delay of beginning of diet. Children with intraabdominal abscess at appendectomy showed higher complication rates than without abscess. Children who underwent operation in the daytime started diet significantly earlier and showed less complication than those operated on at night. The frequency of preoperative antibiotics administration did not alter the postoperative hospital course.
CONCLUSION
For the children diagnosed with perforated appendicitis, non-urgent appendectomy in the daytime after initial conservative management including intravenous administration of antibiotics, hydration, and correction of serum electrolyte is safer and more efficient than performing emergency operation, and moreover there is no necessity for secondary admission for interval appendectomy.

Keyword

Perforated appendicitis; Children; Optimal time for operation

MeSH Terms

Abscess
Administration, Intravenous
Anti-Bacterial Agents
Appendectomy
Appendicitis
Body Temperature
Child
Diet
Emergencies
Female
Humans
Postoperative Complications
Retrospective Studies
Anti-Bacterial Agents

Reference

1. Warner BW, Kulick RM, Stoops MM, Mehta S, Stephan M, Kotagal UR. An evidenced-based clinical pathway for acute appendicitis decreases hospital duration and cost. J Pediatr Surg. 1998. 33:1371–1375.

2. Korner H, Soreide JA, Pedersen EJ, Bru T, Sondenaa K, Vatten L. Stability in incidence of acute appendicitis. A population-based longitudinal study. Dig Surg. 2001. 18:61–66.

3. Janik JS, Ein SH, Shandling B, Simpson JS, Stephens CA. Nonsurgical management of appendiceal mass in late presenting children. J Pediatr Surg. 1980. 15:574–576.

4. Vane DW, Fernandez N. Role of interval appendectomy in the management of complicated appendicitis in children. World J Surg. 2006. 30:51–54.

5. Henry MC, Gollin G, Islam S, Sylvester K, Walker A, Silverman BL, et al. Matched analysis of nonoperative management vs immediate appendectomy for perforated appendicitis. J Pediatr Surg. 2007. 42:19–23.

6. Morrow SE, Newman KD. Current management of appendicitis. Semin Pediatr Surg. 2007. 16:34–40.

7. Aprahamian CJ, Barnhart DC, Bledsoe SE, Vaid Y, Harmon CM. Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences. J Pediatr Surg. 2007. 42:934–938.

8. Sivit CJ, Siegel MJ, Applegate KE, Newman KD. When appendicitis is suspected in children. Radiographics. 2001. 21:247–262.

9. Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA. Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg. 1999. 229:344–349.

10. Partrick DA, Janik JE, Janik JS, Bensard DD, Karrer FM. Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children. J Pediatr Surg. 2003. 38:659–662.

11. Karakas SP, Guelfguat M, Leonidas JC, Springer S, Singh SP. Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol. 2000. 30:94–98.

12. Newman K, Ponsky T, Kittle K, Dyk L, Throop C, Gieseker K, et al. Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg. 2003. 38:372–379.

13. Jaffe BM, Berger DH. Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Pollock RE, editors. The appendix. Schwartz's Principles of Surgery. 2005. 8th ed. New York: McGraw-Hill;1128–1129.

14. Lee SK, Kim DY, Kim SY, Kim SC, Kim SG, Kim WK, et al. Acute appendicitis: a survey by the Korean Association of Pediatric Surgeons in 2006. J Korean Assoc Pediatr Surg. 2007. 13:203–211.

15. Kim SS, Chung SY, Kim SK. Acute appendicitis: clinical characteristics in pediatric age. J Korean Surg Soc. 1997. 52:426–434.

16. Poortman P, Oostvogel HJ, Bosma E, Lohle PN, Cuesta MA, de Lange-de Klerk ES, et al. Improving diagnosis of acute appendicitis: results of a diagnostic pathway with standard use of ultrasonography followed by selective use of CT. J Am Coll Surg. 2009. 208:434–441.

17. Kaiser S, Frenckner B, Jorulf HK. Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology. 2002. 223:633–638.

18. Powers RJ, Andrassy RJ, Brennan LP, Weitzman JJ. Alternate approach to the management of acute perforating appendicitis in children. Surg Gynecol Obstet. 1981. 152:473–475.

19. Skoubo-Kristensen E, Hvid I. The appendiceal mass: results of conservative management. Ann Surg. 1982. 196:584–587.

20. Bagi P, Dueholm S. Nonoperative management of the ultrasonically evaluated appendiceal mass. Surgery. 1987. 101:602–605.

21. Whyte C, Levin T, Harris BH. Early decisions in perforated appendicitis in children: lessons from a study of nonoperative management. J Pediatr Surg. 2008. 43:1459–1463.

22. Ein SH, Shandling B. Is interval appendectomy necessary after rupture of an appendiceal mass? J Pediatr Surg. 1996. 31:849–850.