What is the prognosis of pediatric appendicitis?

Updated: Oct 25, 2018
  • Author: Adam C Alder, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Generally, the prognosis is excellent. At the time of diagnosis, the rate of appendiceal perforation is 20-35%. The rate of perforation is 80-100% for children younger than 3 years, compared with 10-20% in children 10-17 years old. Children with ruptured appendicitis are at risk for intra-abdominal abscess formation and small bowel obstruction, and they can have a prolonged hospital stay (several weeks or more). The mortality rate for children with appendicitis is 0.1-1%.

Initiation of antibiotics represents the single most critical step in the treatment of acute appendicitis.  Multiple studies in children report safety and no increase in rates of perforation once antibiotics are initiated even if the appendectomy is delay to the next morning.  Commonly, the most advanced cases of acute appendicitis are managed exclusively with antibiotics with the appendectomy delayed for several weeks to months, the so-called interval appendectomy.  Data is mounting to expand this approach of using just antibiotics for the acute episode of appendicitis to all types of appendicitis.  Many centers are pursuing this approach in ongoing research trials.

Death from appendicitis is most common in neonates and infants for the following 2 reasons:

  • Appendicitis is rare in this age group; thus, unless the physician’s index of suspicion is high, appendicitis is often low on the list of suspected differential diagnoses.

  • Very young patients are unable to communicate the location and nature of their pain. Some neonates may not even become febrile. Often, the patient’s only symptom is irritability or inconsolability.


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