Non-Operative Management of Acute Uncomplicated Appendicitis in Children

  • Nabibux Napar Ghulam Muhammad Mahar Medical College
  • Noor Ahmed Shaikh Ghulam Muhammad Mahar Medical College, Sukkur
  • Imamuddin Baloch Ghulam Muhammad Mahar Medical College, Sukkur
  • Azhar Ali Shah Ghulam Muhammad Mahar Medical College, Sukkur
  • Ishrat Mahtam Shaikh Zayed Hospital, Larkana
  • Inayatullah Memon Ghulam Muhammad Mahar Medical College, Sukkur
Keywords: Acute appendicitis, Appendicectomy, Conservative management, Non-surgical management, Pediatric surgery, Uncomplicated acute appendicitis

Abstract

Objective: To compare the efficacy of non-surgical conservative management with surgical management in cases of uncomplicated acute appendicitis in children.

Study design: Prospective comparative study.

Settings: Pediatric surgery Department, Ghulam Muhammad Mahar Medical College Sukkur.

Study duration: 1st February 2020 to 31st May 2021.

Materials and Methods: Ninety patients of either gender with age range from 5-12 years, diagnosed as uncomplicated acute appendicitis, were divided in two groups. Group C patients were managed conservatively with antibiotics (ceftriaxone 100 mg/kg/day, amikacin 10mg/kg/day and metronidazole 22.5 mg/kg/day) and maintenance fluids were started. Patients were observed for improvement or any signs of deterioration. Those who deteriorated within 24 hours were managed with surgical management immediately. Follow-ups were carried out after discharge on the 7th day, 1 month, and six months. Patients reporting a recurrence of symptoms were managed with appendicectomy. Group S patients were managed with appendicectomy with the open technique. Patients were observed for post-operative complications.

Results: Demographic data of both groups was comparable. In group C, 34 (75.56%) patients were successfully treated with conservative management, whereas in group S, 39 (86.67%) were successfully treated with surgical management. The difference was insignificant with a p-value of 0.114. In group C, 5 (11.11%) patients did not respond to conservative management and they were managed with appendicectomy and recurrence of symptoms was seen in 6 (13.33%) patients in group C, they were also managed with appendicectomy. In group S, 6 (13.33%) patients suffered post-operative complications. Mean length of stay in hospital was 4.31±1.20 and 4.09±1.12 days in group C and S respectively. This difference was statistically insignificant with a p-value of 0.368.

Conclusion: It is concluded in our study that uncomplicated acute appendicitis in children can be successfully managed with non-surgical conservative management.

References

1. Musbahi A, Rudd D, Dordea M, Gopinath B, Kurup, V. Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population. World Journal of Pediatric Surgery . 2019;2(2):e000040. doi:10.1136/wjps-2019-000040.
2. Sherratt FC, Allin BS, Kirkham JJ, Walker E, Young B, Wood W. Core outcome set for uncomplicated acute appendicitis in children and young people. British Journal of Surgery. 2020;107(8):1013-1022. doi:10.1002/bjs.11508.
3. Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Italian journal of pediatrics. 2017;43(1):15. https://doi.org/10.1186/s13052-017-0335-2.
4. Kim JW, Shin DW, Kim DJ, Kim JY, Park SG, Park JH. Effects of timing of appendectomy on the risks of perforation and postoperative complications of acute appendicitis. World Journal of Surgery. 2017; 42(5):1295-1303. doi:10.1007/s00268-017-4280-4.
5. Poudel R, Bhandari TR. Risk factors for complications in acute appendicitis among paediatric population. Journal of Nepal Medical Association. 2017;56(205):145-148. doi:10.31729/jnma.2930.
6. Dutt DC. Conservative management of acute uncomplicated appendicitis: A first line therapy in tertiary care hospital. Journal of Medical Science And clinical Research. 2018;6(9):55-60. doi:10.18535/jmscr/v6i9.10.
7. Poon SH, Lee JW, NG KM, Chiu GW, Wong BY, Foo CC et al. The current management of acute uncomplicated appendicitis: Should there be a change in paradigm? A systematic review of the literatures and analysis of treatment performance. World Journal of Emergency Surgery. 2017;12(1)46. doi:10.1186/s13017-017-0157-y.
8. Suwanwongse K, Shabarek N. Successful Conservative Management of Acute Appendicitis in a Coronavirus Disease 2019 (COVID-19) Patient. Cureus. 2020;12(4):e7834. https://doi.org/10.7759/cureus.7834.
9. Maini SK, Jain NK, Jain MG, Khobragade V. Conservative management of early uncomplicated appendicitis in children. International Surgery Journal. 2017;4(3):1024. doi:10.18203/2349-2902.isj20170855.
10. Almström M, Svensson JF, Svenningsson A, Hagel E, Wester T. Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013. BJS Open. 2018;2(3):142-150. doi:10.1002/bjs5.52.
11. Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. American Family Physician. 2018;98(1):25-33.
12. Nakashima M, Takeuchi M, Kawakami K. Clinical outcomes of acute appendicitis during pregnancy: Conservative management and appendectomy. World Journal of Surgery. 2021;45(6):1717-1724. doi:10.1007/s00268-021-06010-w.
13. Alnaser MK, Hassan QA, Hindosh LN. Effectiveness of conservative management of uncomplicated acute appendicitis: A single hospital based prospective study. International Journal of Surgery Open. 2018;10(1):1-4. doi:10.1016/j.ijso.2017.11.007.
14. Steiner Z, Buklan G, Stackievicz R, Gutermacher M, Erez I. A role for conservative antibiotic treatment in early appendicitis in children. Journal of Pediatric Surgery. 2015; 50(9), 1566-1568. doi:10.1016/j.jpedsurg.2015.04.008.
15. Minneci, PC, Sulkowski JP, Nacion KM, Mahida JB, Cooper JN, Moss RL, et al. Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children. Journal of the American College of Surgeons. 2014; 219(2):272-279. doi:10.1016/j.jamcollsurg.2014.02.031.
16. Charalampopoulos A, Koliakos N, Bagias G, Bompetsi G, Zavras N, Davris D, et al. Acute appendicitis: After correct diagnosis conservative treatment or surgery? Intech Open. 2021; 1(1):1-6doi:10.5772/intechopen.95870.
17. Safirullah, Khan M, Ahmed S, Mumtaz N. Conservative treatment of appendicular mass without interval appendicectomy: is it justified? Journal of Postgraduate Medical Institute. 2007; 21(1):55-59.
18. Paudel GR, Agrawal CS, Regmi R, Agrawal S. Conservative Treatment in Acute Appendicitis. Journal of the Nepal Medical Association. 2010;50(180):295-299.
Published
2022-06-30
How to Cite
1.
Napar N, Shaikh N, Baloch I, Shah A, Mahtam I, Memon I. Non-Operative Management of Acute Uncomplicated Appendicitis in Children. JRMC [Internet]. 30Jun.2022 [cited 12Aug.2022];26(2):276-9. Available from: https://journalrmc.com/index.php/JRMC/article/view/1859
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Articles

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