In Pediatric Patients with Presumed Appendicitis, Is the Urgent Appendectomy the Best?: Appropriate Management for Pediatric Patients with Presumed Acute Appendicitis

ABSTRACT

PURPOSE: The emerging studies have suggested steadily negative appendectomy rates. The purpose of this study is to verify that short-term observation under conservative management helps surgeons avoid unnecessary surgery without poor progress in pediatric patients with presumed acute appendicitis. METHODS: We reviewed 650 medical records of pediatric patients aged 12 years and younger with presumed acute appendicitis at Ewha Womans University Medical Center between January 2005 and December 2009. We then compared 283 'appendectomy group (AG)' including 229 suppurative appendicitis (SA) and 54 normal appendix or mild appendicitis (MA), pathologically, with 96 'conservative treatment group (CG)' who were diagnosed with mesenteric lymphadenopathy associated with early appendicitis or normal appendix in radiologic study and effectively treated with conservative management. RESULTS: There was no significant difference in gender and age distribution between SA and MA groups, but the mean age of CG was younger than MA group (P=0.000). The main clinical findings between SA, MA and CG were similar but the mean duration of symptom was longest in CG. 'Delayed' and 'night-time' surgery was frequent in MA (P=0.006, P=0.027). Thirteen patients(4.6%) developed complications in AG without significant difference between SA and MA. The mean hospital stay was significantly shorter in CG than MA (P=0.000) without significant difference between SA and MA. The medical cost of CG was much cheaper than AG (P=0.000). No patient in CG needed appendectomy for the follow-up period. CONCLUSION: The authors suggested that short-term watchful waiting for presumed appendicitis in pediatric patients under conservative treatment could reduce unnecessary appendectomy, complications and cost.