Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety.
Eur J Pediatr
; 176(4): 521-527, 2017 Apr.
Article
en En
| MEDLINE
| ID: mdl-28210834
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.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Apendicitis
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Tratamiento Conservador
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Antibacterianos
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adolescent
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Child
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Female
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Humans
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Male
Idioma:
En
Revista:
Eur J Pediatr
Año:
2017
Tipo del documento:
Article
País de afiliación:
Israel