Management of perforated appendicitis in children: A decade of aggressive treatment

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      Perforated appendicitis in children continues to be associated with significant morbidity. In 1976, a treatment algorithm was begun at the authors' institution, which included immediate appendectomy, antibiotic irrigation of the peritoneal cavity, transperitoneal drainage through the wound, and 10-day treatment with intravenous ampicillin, clindamycin, and gentamicin. Initial results with this scheme in 143 patients demonstrated a 7.7% incidence of major complications and no deaths. From 1981 through 1991, the authors continued to use this treatment plan in all patients with perforated appendicitis. Three hundred seventy-three patients with perforated appendicitis were treated, and the rate of major complications was 6.4%. Infectious complications occurred in 18 patients (4.8%) and included intraabdominal abscesses (5 patients, 1.3%), phlegmon treated with an extended course of antibiotics (6 patients, 1.6%), wound infections (5 patients, 1.3%), and enterocutaneous fistula requiring further operations (2 patients, 0.5%). There were six cases of small bowel obstruction (1.6%), which required operative intervention. There were no deaths. The average length of stay all patients was 11.4 days (range, 8 to 66 days). Utilization of transperitoneal drainage and choice of antibiotic therapy continue to be sources of controversy in the surgical literature. However, the treatment plan used in the present study resulted in the lowest complication rate reported to date, and the authors conclude that this scheme in truly the “gold standard” for treatment of perforated appendicitis. New treatment plans using laparoscopic appendectomy, different or shorter courses of antibiotics, or not using drain should have complication rates that are as low as, or lower than this one to be considered as useful alternatives.


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        • Schwartz MZ
        • Tapper D
        • Solenberger RI
        Management of perforated appendicitis in children.
        Ann Surg. 1983; 197: 407-411
        • Stone HH
        • Sanders SL
        • Martin Jr, JD
        Perforated appendicitis in children.
        Surg. 1971; 69: 673-679
        • David IB
        • Buck JR
        • Filler RM
        Rational use of antibiotics for perforated appendicitis in childhood.
        J Pediatr Surg. 1982; 17: 494-500
        • Marchildon MB
        • Dudgeon DL
        Perforated appendicitis: A current experience in a children's hospital.
        Ann Surg. 1977; 185: 84-87
        • Berne TV
        • Yellin AE
        • Appleman MD
        • et al.
        Surgically treated gangrenous or perforated appendicitis. A comparison of aztreonam and clindamycin versus gentamicin and clindamycin.
        Ann Surg. 1987; 205: 133-137
        • Schropp KP
        • Kaplan S
        • Golladay ES
        • et al.
        A randomized clinical trial of ampicillin, gentamicin and clindamycin versus cefotaxime and clindamyoin in children with ruptured appendicitis.
        Surg Gynecol Obstet. 1991; 172: 351-356
        • Heseltine PN
        • Yellin AE
        • Appleman MD
        • et al.
        Imipenem therapy for perforated and gangrenous appendicitis.
        Surg Gynecol Obstet. 1986; 162: 43-48
        • Sirinek KR
        • Levine BA
        A randomized trial of ticarcillin and clavulanate versus gentamicin and clindamycin in patients with complicated appendicitis.
        Surg Gynecol Obstet. 1991; 172 (suppl): 30-35
        • Pokorny WJ
        • Kaplan SL
        • Mason Jr, EO
        A preliminary report of ticarcillin and clavulanate versus triple antibiotic therapy in children with ruptured appendicitis.
        Surg Gynecol Obstet. 1991; 172 (suppl): 54-56
        • Meller JL
        • Reyes HM
        • Loeff DS
        • et al.
        One-drug versus two-drug antibiotic therapy in pediatric perforated appendicitis: A prospective randomized study.
        Surg. 1991; 110: 764-768
        • Gill MA
        • Chenella FC
        • Heseltine PN
        • et al.
        Cost analysis of antibiotics in the management of perforated or gangrenous appendicitis.
        Am J Surg. 1986; 151: 200-204
        • Lewin J
        • Fenyo G
        • Engstrom L
        Treatment of appendiceal abscess.
        Acta Chir Scand. 1988; 154: 123-125
        • Elmore JR
        • Dibbins AW
        • Curci MR
        The treatment of complicated appendicitis in children. What is the gold standard?.
        Arch Surg. 1987; 122: 424-427
        • Othersen Jr, HB
        • Campbell Jr, TW
        Programmed treatment of ruptured appendicitis in children.
        South Med J. 1974; 67: 903-907
        • Burnweit C
        • Bilik R
        • Shanding B
        Primary closure of contaminated wounds in perforated appendicitis.
        J Pediatr Surg. 1991; 26: 1362-1365
        • Stovroff MC
        • Totten M
        • Glick PL
        PIC lines save money and hasten discharge in the care of children with ruptured appendicitis.
        J Pediatr Surg. 1994; 29: 245-247