Adv Pediatr Surg.  2019 Jun;25(1):7-13. 10.13029/aps.2019.25.1.7.

Nonoperative Treatment of Appendicitis in the Pediatric Population: Stringent Patient Selection for Successful Application

• Son J
• Lee S
• Hong J
• Seo JM
• Lee SK

• KMID: 2451062
• DOI: http://doi.org/10.13029/aps.2019.25.1.7

Abstract

PURPOSE
Although nonoperative treatment of appendicitis (NOTA) in the pediatric population has been well reported recently, patient selection and treatment scheme varies among studies, making it difficult to establish treatment standards for NOTA.
METHODS
In a single medical center, patients younger than 18 years who were diagnosed with appendicitis: 1) with abdominal pain not exceeding 24 hours, 2) without radiologic evidence of appendicolith or appendiceal perforation or pelvic abscess, and 3) without signs of frank generalized peritonitis were offered NOTA, and their data were prospectively collected.
RESULTS
Twenty-two patients with uncomplicated appendicitis agreed to NOTA and were enrolled in the study. The initial success rate (resolution of abdominal pain and hospital discharge without appendectomy) was 100% (22 out of 22 patients). At a median follow-up period of 23.8 months, two patients had recurrence at two and three months after completion of NOTA. These patients underwent laparoscopic appendectomy.
CONCLUSION
Stringent patient selection may be necessary to apply NOTA safely for all children with uncomplicated appendicitis. Further studies concerning patient selection and conformed treatment protocols for NOTA are required.

Keyword

Appendicitis; Antibiotics; Appendectomy

MeSH Terms

Abdominal Pain
Abscess
Anti-Bacterial Agents
Appendectomy
Appendicitis*
Child
Clinical Protocols
Follow-Up Studies
Humans
Patient Selection*
Peritonitis
Prospective Studies
Recurrence
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Management protocol for NOTA. NOTA, nonoperative treatment of appendicitis; IV, intravenous; ER, emergency room; NPO, nothing by mouth; NRS, Numeric Rating Scale; OPD, outpatient department; f/u, follow-up.

• 

  Fig. 2 Flow chart of patient selection and results. NOTA, nonoperative treatment of appendicitis.

• 

  Fig. 3 (A) Pain score reduction according to HD (NRS) (p<0.001). (B) (WBC count reduction of patients (p<0.001). (C) CRP count reduction of patients (p<0.001). NRS, Numeric Rating Scale; WBC, white blood cell; CRP, C-reactive protein; ER, emergency room; HD, hospital day; OPD, outpatient department. *p<0.05.

• 

  Fig. 4 Kaplan-Meier curve of patients undergone nonoperative treatment of appendicitis to be free from appendectomy.

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