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Management of Perforated Appendicitis in Children—Revisited

Management of Perforated Appendicitis in Children—Revisited Abstract • Of 522 children with acute appendicitis treated from 1978 to 1985, 170 had appendiceal perforation with peritonitis. The protocol for perforation included aggressive fluid resuscitation, preoperative triple antibiotic therapy, copious peritoneal lavage, avoidance of transperitoneal drains except those used for well-localized abscesses, delayed wound closure, and postoperative antibiotic therapy for seven to ten days. The minor complication rate was 22%; this included pleural effusion, wound infection, atelectasis, and prolonged ileus. The major complication rate was 3%; this included intra-abdominal abscess, gastrointestinal bleeding, wound dehiscence, pneumonia, and intestinal obstruction. Only four postoperative intra-abdominal abscesses occurred, in three patients. The mortality rate was zero. A comparison of this series with a similar group of 24 patients who underwent drainage showed the relative rate of abdominal abscess formation to be 1.8% (undrained) vs 12.5% (drained). We achieved our lowest rate of serious complications following surgery for pediatric perforated appendix with the use of aggressive fluid resuscitation, broad-spectrum antibiotic therapy, copious peritoneal irrigation, and delayed wound closure and without drainage. (Arch Surg 1987;122:691-696) References 1. Janik JS, Firor HV: Pediatric appendicitis: A 20-year study of 1,640 children at Cook County (Ill) Hospital . Arch Surg 1979;114:717-719.Crossref 2. Marcuse EK, Koepsell TD, Hatch EI: Childhood appendicitis: Factors associated with perforation . Pediatrics 1985;76:301-306. 3. Graham JM, Pokorny WJ, Harberg FJ: Acute appendicitis in preschool age children . Am J Surg 1980;139:247-250.Crossref 4. Savrin RA, Clatworthy HW: Appendiceal rupture: A continuing diagnostic problem . Pediatrics 1979;63:37-43. 5. Condon RE: Appendicitis , in Sabiston DC (ed): Textbook of Surgery . Philadelphia, WB Saunders Co, 1985, p 969. 6. Lewis FR, Holcroft JW, Dunphy JE: Appendicitis: A critical review of diagnosis and treatment in 1000 cases . Arch Surg 1975;110:677.Crossref 7. Stone HH, Sanders SL, Martin JD: Perforated appendicitis in children . Surgery 1971;69:673-679. 8. Holgersen LO, Stanley-Brown EG: Acute appendicitis with perforation . AJDC 1971;122:288-293. 9. Grosfeld JL, Solit RW: Prevention of wound infection in perforated appendicitis: Experience with delayed primary wound closure . Ann Surg 1968;168:891-895.Crossref 10. Bower RJ, Bell MJ, Ternberg JL: Controversial aspects of appendicitis management in children . Arch Surg 1981;116:885-887.Crossref 11. Marchildon MB, Dudgeon DL: Perforated appendicitis: Current experiences in a children's hospital . Ann Surg 1977;185:84-87.Crossref 12. Schwartz MZ, Tapper D, Solenberger RI: Management of perforated appendicitis in children: The controversy continues . Ann Surg 1983;197: 407-411.Crossref 13. Puri P, O'Donnell B: Appendicitis in infancy . J Pediatr Surg 1978;13: 173-174.Crossref 14. Haller JA, Shaker IJ, Donahoo JS, et al: Peritoneal drainage vs nondrainage for generalized peritonitis from ruptured appendicitis in children: A prospective study . Ann Surg 1973;177:595-600. 15. Greenall MJ, Evans M, Pollack AV: Should you drain a perforated appendix? Br J Surg 1978;65:880-882.Crossref 16. Stone HH, Hooper CA, Millikan WJ: Abdominal drainage following appendectomy and cholecystectomy . Ann Surg 1978;187:606-612.Crossref 17. Yates JL: An experimental study of the local effects of peritoneal drainage . Surg Gynecol Obstet 1905;1:473. 18. Simmons RL: Peritonitis and Intra-abdominal Abscesses: Principles Governing Treatment . Kalamazoo, Mich, Upjohn Co, 1981. 19. Sherman JO, Luck SR, Borger JA: Irrigation of the peritoneal cavity for appendicitis in children: A double-blind study . J Pediatr Surg 1976;11: 371-374.Crossref 20. Skau T, Nystrom P-O, Öhman L, et al: The kinetics of peritoneal clearance of Escherichia coli and Bacteroides fragilis and participating defense mechanisms . Arch Surg 1986;121:1033-1039.Crossref 21. Raahave D, Friis-Møller A, Bjerre-Jepsen K, et al: The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis . Arch Surg 1986;121:924-929.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Management of Perforated Appendicitis in Children—Revisited

Archives of Surgery , Volume 122 (6) – Jun 1, 1987

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400180073014
Publisher site
See Article on Publisher Site

Abstract

Abstract • Of 522 children with acute appendicitis treated from 1978 to 1985, 170 had appendiceal perforation with peritonitis. The protocol for perforation included aggressive fluid resuscitation, preoperative triple antibiotic therapy, copious peritoneal lavage, avoidance of transperitoneal drains except those used for well-localized abscesses, delayed wound closure, and postoperative antibiotic therapy for seven to ten days. The minor complication rate was 22%; this included pleural effusion, wound infection, atelectasis, and prolonged ileus. The major complication rate was 3%; this included intra-abdominal abscess, gastrointestinal bleeding, wound dehiscence, pneumonia, and intestinal obstruction. Only four postoperative intra-abdominal abscesses occurred, in three patients. The mortality rate was zero. A comparison of this series with a similar group of 24 patients who underwent drainage showed the relative rate of abdominal abscess formation to be 1.8% (undrained) vs 12.5% (drained). We achieved our lowest rate of serious complications following surgery for pediatric perforated appendix with the use of aggressive fluid resuscitation, broad-spectrum antibiotic therapy, copious peritoneal irrigation, and delayed wound closure and without drainage. (Arch Surg 1987;122:691-696) References 1. Janik JS, Firor HV: Pediatric appendicitis: A 20-year study of 1,640 children at Cook County (Ill) Hospital . Arch Surg 1979;114:717-719.Crossref 2. Marcuse EK, Koepsell TD, Hatch EI: Childhood appendicitis: Factors associated with perforation . Pediatrics 1985;76:301-306. 3. Graham JM, Pokorny WJ, Harberg FJ: Acute appendicitis in preschool age children . Am J Surg 1980;139:247-250.Crossref 4. Savrin RA, Clatworthy HW: Appendiceal rupture: A continuing diagnostic problem . Pediatrics 1979;63:37-43. 5. Condon RE: Appendicitis , in Sabiston DC (ed): Textbook of Surgery . Philadelphia, WB Saunders Co, 1985, p 969. 6. Lewis FR, Holcroft JW, Dunphy JE: Appendicitis: A critical review of diagnosis and treatment in 1000 cases . Arch Surg 1975;110:677.Crossref 7. Stone HH, Sanders SL, Martin JD: Perforated appendicitis in children . Surgery 1971;69:673-679. 8. Holgersen LO, Stanley-Brown EG: Acute appendicitis with perforation . AJDC 1971;122:288-293. 9. Grosfeld JL, Solit RW: Prevention of wound infection in perforated appendicitis: Experience with delayed primary wound closure . Ann Surg 1968;168:891-895.Crossref 10. Bower RJ, Bell MJ, Ternberg JL: Controversial aspects of appendicitis management in children . Arch Surg 1981;116:885-887.Crossref 11. Marchildon MB, Dudgeon DL: Perforated appendicitis: Current experiences in a children's hospital . Ann Surg 1977;185:84-87.Crossref 12. Schwartz MZ, Tapper D, Solenberger RI: Management of perforated appendicitis in children: The controversy continues . Ann Surg 1983;197: 407-411.Crossref 13. Puri P, O'Donnell B: Appendicitis in infancy . J Pediatr Surg 1978;13: 173-174.Crossref 14. Haller JA, Shaker IJ, Donahoo JS, et al: Peritoneal drainage vs nondrainage for generalized peritonitis from ruptured appendicitis in children: A prospective study . Ann Surg 1973;177:595-600. 15. Greenall MJ, Evans M, Pollack AV: Should you drain a perforated appendix? Br J Surg 1978;65:880-882.Crossref 16. Stone HH, Hooper CA, Millikan WJ: Abdominal drainage following appendectomy and cholecystectomy . Ann Surg 1978;187:606-612.Crossref 17. Yates JL: An experimental study of the local effects of peritoneal drainage . Surg Gynecol Obstet 1905;1:473. 18. Simmons RL: Peritonitis and Intra-abdominal Abscesses: Principles Governing Treatment . Kalamazoo, Mich, Upjohn Co, 1981. 19. Sherman JO, Luck SR, Borger JA: Irrigation of the peritoneal cavity for appendicitis in children: A double-blind study . J Pediatr Surg 1976;11: 371-374.Crossref 20. Skau T, Nystrom P-O, Öhman L, et al: The kinetics of peritoneal clearance of Escherichia coli and Bacteroides fragilis and participating defense mechanisms . Arch Surg 1986;121:1033-1039.Crossref 21. Raahave D, Friis-Møller A, Bjerre-Jepsen K, et al: The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis . Arch Surg 1986;121:924-929.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1987

References