Current management of appendicitis

https://doi.org/10.1053/j.sempedsurg.2006.10.005Get rights and content

Appendicitis is the most common surgical disease of the abdomen in children. Pediatric appendicitis varies considerably in its clinical presentation, contributing to delay in diagnosis and increased morbidity. The methods of diagnosis and treatment of appendicitis also vary significantly among clinicians and medical centers according to the patient’s clinical status, the medical center’s capabilities, and the physician’s experience and technical expertise. Recent trends include the increased use of radiologic imaging, minimally invasive and nonoperative treatments, shorter hospital stays, and home antibiotic therapy. Little consensus exists regarding many aspects of the care of the child with complicated appendicitis. This article examines the most debated aspects of the diagnosis and management of the diseased pediatric appendix.

Section snippets

Treatment

The treatment of appendicitis depends on both the patient’s general condition and the state of the appendix. Children with appendicitis are often dehydrated and may be febrile, acidotic, and septic. Intravenous fluids and antibiotics are always indicated preoperatively. The antibiotic regimen selected should be effective against the bacterial flora found in the appendix, which consists chiefly of anaerobes and Gram-negative coliforms. Anaerobes make up most of the colonic flora and include

Summary

Appendicitis in children is common and continues to challenge even the most experienced clinician. The spectrum of its clinical presentation varies from subtle, vague abdominal complaints to life-threatening septic shock and often mimics other disorders. The response of the patient’s immune system varies considerably for similar degrees of appendiceal inflammation found at operation. There are, unfortunately, no preoperative tests for appendicitis with perfect sensitivity and specificity. Some

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