Non-operative management of early, acute appendicitis in children: Is it safe and effective?

PurposeThe purpose of this study was to determine if early, acute appendicitis in children can be safely and effectively managed with antibiotics alone.MethodsA retrospective review was performed of children (< 18 yrs) treated non-operatively (NOM) for early, acute appendicitis since May 2012. These were compared to patients treated with appendectomy between January 2011 and October 2011 (OM). Inclusion criteria included: (a) symptoms < 48 h, (b) localized peritonitis, and (c) ultrasound findings consistent with early, acute appendicitis.ResultsTwelve patients (66% female, mean age 12.2,SD = 4.2 yrs) were treated non-operatively, while 12 (50% female, mean age 12.5,SD = 3.2 yrs) were treated operatively. Two NOM children (16.7%) required initial appendectomy. One patient developed recurrent appendicitis requiring appendectomy 7 months post-discharge. Four other NOM patients returned with symptoms but did not require admission or surgery. Two OM patients (8.3%) had hospital visits and admissions related to surgical site infections. Mean length of stay (LOS) for the first visit was 1.5 days (SD = 1.0d) (NOM) vs. 1.3 days (SD = 0.5d) (OM) (p = 0.61). Including first and subsequent admissions, mean LOS was 1.8 days (SD = 1.1d) (NOM) vs. 1.7 days (SD = 1.5d) (OM) (p = 0.97).ConclusionEarly acute appendicitis in appropriately selected children can be successfully treated non-operatively. Randomized trials with longer follow-up are required.