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Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety

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Abstract

The success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3–5 days, and if symptoms resolved, were discharged home on oral antibiotics for 5 days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18 months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60–84] vs. 84 h [72–126], P = 0.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (P = 0.028 and P = 0.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratio = 10.2; 95% CI 3.3–31.8, P = 0.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices.

Conclusion: When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure.

What is Known:

• Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy.

What is New:

• Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible.

• Intraluminal fluid should be considered a contraindication to conservative treatment.

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Abbreviations

AA:

Acute appendicitis

ILF:

Intraluminal fluid

US:

Ultrasound

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Authors’ contributions

Drs. Steiner and Arnon contributed to the study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision.

Drs. Buklan, Gutermacher, and Golani contributed to the study conception and design and to the acquisition of data.

Dr. Stackievicz contributed to the acquisition of data

Dr. Litmanovitz was involved in drafting the manuscript.

All authors approved the final version and agreed with its submission to the journal.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel

    Zvi Steiner, Genady Buklan, Michael Gutermacher & Guy Golani

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Zvi Steiner, Genady Buklan, Rodica Stackievicz, Michael Gutermacher, Ita Litmanovitz & Shmuel Arnon

  3. Department of Radiology, Meir Medical Center, Kfar Saba, Israel

    Rodica Stackievicz

  4. Department of Neonatology, Meir Medical Center, Kfar Saba, Israel

    Ita Litmanovitz & Shmuel Arnon

Authors
  1. Zvi Steiner
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  2. Genady Buklan
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  3. Rodica Stackievicz
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  4. Michael Gutermacher
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  5. Ita Litmanovitz
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  6. Guy Golani
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  7. Shmuel Arnon
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Corresponding author

Correspondence to Zvi Steiner.

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Funding

The study was not funded.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of Meir Medical Center, Kfar Saba, Israel. Informed consent was obtained from the parents of all individual participants included in the study.

Additional information

Communicated by Peter de Winter

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Steiner, Z., Buklan, G., Stackievicz, R. et al. Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety. Eur J Pediatr 176, 521–527 (2017). https://doi.org/10.1007/s00431-017-2867-2

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  • DOI: https://doi.org/10.1007/s00431-017-2867-2

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