Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety

Zvi Steiner, Genady Buklan, Rodica Stackievicz, Michael Gutermacher, Ita Litmanovitz, Guy Golani, Shmuel Arnon

Research output: Contribution to journalArticlepeer-review

Abstract

The success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3–5 days, and if symptoms resolved, were discharged home on oral antibiotics for 5 days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18 months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60–84] vs. 84 h [72–126], P = 0.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (P = 0.028 and P = 0.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratio = 10.2; 95% CI 3.3–31.8, P = 0.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices. Conclusion: When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure.What is Known:• Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy.What is New:• Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible.• Intraluminal fluid should be considered a contraindication to conservative treatment.

Original languageEnglish
Pages (from-to)521-527
Number of pages7
JournalEuropean Journal of Pediatrics
Volume176
Issue number4
DOIs
StatePublished - 1 Apr 2017

Keywords

  • Acute appendicitis
  • Appendectomy
  • Children
  • Conservative treatment
  • Intraluminal fluid

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