The initial nonoperative management of perforated appendicitis fails in 15% to 25% of children.
These children have complications and increased hospitalization.
Dr Charles Aprahamian and colleagues from Alabama, USA identified predictors of failure of nonoperative management of perforated appendicitis.
The team reviewed 75 children with perforated appendicitis treated with antibiotics and intent for nonoperative management over a 4-year period were.
Failure was defined as undergoing appendectomy before the initially planned interval.
|The failed group underwent 3 times as many CT scans|
|Journal of Pediatric Surgery|
The research team found that 12% of the patients required appendectomy sooner than initially planned.
The team noted that age, presenting symptoms, physical examination findings, and white blood cell count were similar in both success and failure groups.
Absence of abscess and presence of appendicolith were both predictors of failure in a multivariate analysis, which included the presence of small bowel obstruction.
The failed group had a longer median total length of stay.
The team noted that the failed group underwent 3 times as many computed topography (CT) scans as successes.
Dr Aprahamian's team concluded, "Lack of abscess and presence of an appendicolith predict failure of nonoperative management of perforated appendicitis in children even when the effect of small bowel obstruction is accounted for."
"Children with these characteristics may benefit from alternative management strategies."