Original articleNonoperative management of pediatric ruptured appendix with inflammatory mass or abscess: presence of an appendicolith predicts recurrent appendicitis
Section snippets
Materials and methods
Ninety-six pediatric patients (52 girls, 44 boys), aged 16 months to 17 years (average, 7 years), were managed at the Hospital for Sick Children (HSC), Toronto, Canada, between January 1980 and January 2003 (Fig. 1) for ruptured appendicitis with an inflammatory mass or abscess proven by history, examination, plain abdominal radiographs, barium enema, ultrasonography (US), and/or computed tomography. The decision to treat the patient nonoperatively was made by the staff surgeon. None of these
Results
Six children (all with an appendicolith) became worse (4 increasing symptoms and signs, 1 appendiceal fistula, and 1 small bowel obstruction) within 1 month of treatment. Five were operated on immediately, and 1 had another large inflammatory mass, was treated with triple antibiotics again, improved, was discharged home, and had an interval appendectomy. They were eliminated from the study group.
Of the remaining 90 patients, 41 (46%) had an elective interval appendectomy within 1 to 11 months
Discussion
At HSC, there are about 270 cases of appendicitis per year [9], of which 20% are ruptured. One half of the ruptured appendices present with an inflammatory mass or abscess [10]. In 1980 [11], we reported our experience with “37 late presenting children with appendiceal mass…treated between 1965 and 1975…(with no antibiotics) and there was one recurrence before all the others had a successful interval appendectomy.” Sixteen years later (1996) [8], we reported a smaller 10-year (1980-1989)
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2020, Journal of Pediatric SurgeryCitation Excerpt :The presence of an appendicolith increases the risk of recurrent appendicitis following nonoperative management of complicated appendicitis. One prospective pediatric study reported a recurrence rate of 72% when a fecolith was present versus only 26% among those without a fecolith [11]. Similarly, retrospective studies of children treated medically for perforated appendicitis found that evidence of a fecolith on imaging was associated with increased risk of recurrence [12,13].