Complicated appendicitis in children: a clear role for drainage and delayed appendectomy - 21/08/11
, Jennifer L. Bruny, M.D. b, Michael J. Allshouse, D.O. b, Frederick M. Karrer, M.D. b, Moritz M. Ziegler, M.D. b
Corresponding author. Tel.: +1-720-777-6571; fax: +1-720-777-7172.Abstract |
Introduction |
Children presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy.
Methods |
A retrospective review of all children undergoing appendectomy over a 5-year period was performed.
Results |
We identified 1,106 children: 360 had evidence of perforation and 92 had an intra-abdominal abscess or right lower quadrant phlegmon. Of these 92, 60 underwent primary appendectomy and 32 underwent drainage and/or antibiotic therapy with delayed appendectomy. Children undergoing delayed appendectomy had a longer prodrome of symptoms (6.9 vs 4.6 days, P = .002), slightly higher presenting white blood cell count (19.3 vs 16.6, P = .08), and had the same hospital length of stay, yet had a lower complication rate requiring readmission to the hospital (0% vs 10%) compared to those undergoing immediate appendectomy.
Conclusion |
In children presenting with prolonged symptoms and a discrete appendiceal abscess or phlegmon, drainage and delayed appendectomy should be the treatment of choice.
Le texte complet de cet article est disponible en PDF.Keywords : Complicated appendicitis, Delayed appendectomy, Pediatric, Perforated appendicitis, Laparoscopy
Plan
Vol 194 - N° 6
P. 769-773 - décembre 2007 Retour au numéro
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