What is the role of surgery in the treatment of pediatric appendicitis?

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

The definitive treatment for appendicitis is appendectomy. Historically, appendectomy had a 10-20% false-positive rate, but the widespread use of imaging studies has reduced this rate.

Patients with perforated appendicitis can be divided into 2 cohorts; those whose perforation is discovered in the operating room during appendectomy and those with preoperative evidence of perforation, most commonly seen on CT scans or ultrasounds. Increasingly, the approach in the latter group is conservative (nonoperative) management, with percutaneous drainage if possible and surgery after 8-12 weeks (ie, interval appendectomy).

Patients discovered to have perforated appendicitis during appendectomy should be treated in the same fashion as those with nonperforated appendicitis. The surgeon should complete the appendectomy in a normal fashion.

If a laparoscopic appendectomy is being performed, perforation alone is not a reason for conversion to open appendectomy. However, if an abscess is encountered and drained, placement of a drain in the abscess cavity should be considered. In addition, when an open appendectomy is being performed on a patient with a perforated appendix, the high incidence of wound infection should be considered in terms of skin closure.

In rare instances, the inflammation can be so severe that the appendix cannot be safely identified and removed. To avoid unnecessary morbidity, drainage procedures with subsequent interval appendectomy (see conservative [nonoperative] management) is acceptable.

To see complete information on Pediatric Appendectomy, please go to the main article.


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