New Criteria Could Improve the Success Rate of Non-operative Management of Acute Appendicitis in Children

Abstract

Background: Most studies addressing non-operative management for acute appendicitis have focused on adults, and there are limited data available for children. We aimed to evaluate the results of successful nonoperative management in children with acute uncomplicated appendicitis with our additional criteria and find which factors could be affecting the success rate and which cases could be candidates for non-operative management. Materials and methods: A total of 54 patients who were diagnosed with acute uncomplicated appendicitis and received non-operative management were re-evaluated retrospectively. Defining uncomplicated appendicitis was based on the duration of symptoms (<24 hours), clinical history, and radiologic findings. The radiologic evaluation was based on ultrasonography and computed tomography. The patients received an intravenous antibiotic combination (sulbactam/ampicillin, gentamicin, clindamycin) for five days at the hospital; the treatment was completed after 10 days with an oral antibiotic combination (amoxicillin/clavulanate, metronidazole). The cases have a follow-up period of up to two years. Results: The mean patient age and follow-up time were 13.0 +/- 4 years and 41.6 +/- 13 months, respectively. The mean leukocyte count, C-reactive protein (CRP), and appendix diameter values were 15.48 +/- 6.4 x 109/L, 11.79 +/- 24.5 mg/dL, and 7.76 +/- 1.4 mm on admission, and 6.86 +/- 12.4 x 109/L, 4.17 +/- 10.3 mg/dL, and 5.82 +/- 1.6 mm on the second day, respectively. This decrease in WBC./CRP values and appendix diameter was statistically significant (p < 0.001). None of the patients had an early failure, complication, or adverse event. Recurrent appendicitis occurred in only five cases (9%) that were treated by laparoscopic appendectomy during the follow-up. Conclusion: Non-operative management for acute uncomplicated appendicitis in children regarding long-term outcomes with our criteria was satisfactory and initial success rates were excellent.