The trials of conservative treatment of acute uncomplicated appendicitis in the paediatric population: A pilot study.
TL;DR
Conservative treatment has proved to be effective in 100% of cases, supporting the feasibility of conservative management in appropriate cases, and a unique opportunity to review the effectiveness of medical treatment of uncomplicated acute appendicitis.
Abstract
Aim
OF THE STUDY Acute appendicitis is the most common paediatric surgical emergency. Although appendicectomy remains the gold standard, conservative management with antibiotics has gained attention following promising results from recent trials such as CONTRACT. This study reviews outcomes of conservatively managed, ultrasound-confirmed appendicitis in a paediatric cohort.
Method
A retrospective review was conducted of paediatric patients (<16 years) admitted with appendicitis between April 2020 and April 2022. Only cases with ultrasound-confirmed appendicitis were included. Patients with radiological evidence of perforation or abscess were excluded. Where the appendix was not directly visualised, inclusion required secondary inflammatory sonographic findings and an overall radiologist impression supporting acute appendicitis. Demographic, haematological and radiological data, treatment outcomes and length of stay were analysed using SPSS.
Results
68 children had ultrasound-confirmed appendicitis; 13 (19%) were managed conservatively and 55 (81%) surgically. The mean age of conservatively managed patients was 11.4 ± 2.6 years, with 54% male. All conservatively managed patients achieved full recovery without recurrence or subsequent appendicectomy during a mean 4-year follow-up. Mean white cell count (WCC) was lower in the conservative group (12.3 ± 3.8 × 109/L) than in the surgical group (13.7 ± 4.1 × 109/L, p = 0.03), while C-reactive protein and neutrophil counts were similar (p > 0.05). WCC and CRP correlated positively (r = 0.41, p < 0.05). Mean length of stay was 2.45 days for conservatively managed and 3.57 days for surgically managed patients (p > 0.05).
Conclusion
Whilst the majority of patients presenting to hospital were treated surgically (81%), a substantial amount were treated conservatively (19%), giving a unique opportunity to review the effectiveness of medical treatment of uncomplicated acute appendicitis. Conservative treatment has proved to be effective in 100% of cases, supporting the feasibility of conservative management in appropriate cases.