The Present Scenario and Management Strategies of Pediatric Appendicitis

A BSTRACT Background and Aims: Despite contemporary discussion on the clinical presentation, imaging studies, indications of appendicectomy, and the best available approach, a diagnostic delay due to atypical presentations of appendicitis in preschool children is the current main cause of morbidity or mortality. Our aim is to reevaluate the present scenario of pediatric appendicitis and management strategies in our institution. Materials and Methods: The study was conducted with hospital records of 128 patients (below the age of 12 years) with appendicitis, who were managed (surgically or conservatively) in our institute during the last five years. Basic demographic data, presenting symptoms, radiological findings, mode of intervention, records of perioperative hospital care, and outcome were cumulated and inspected. Results: Among 128 cases, 37 (28.9%) had complications at presentation. Complicated appendicitis was more consistent with younger and higher C-reactive protein (CRP) at presentation. For 48 patients (37.5%), laparoscopic surgery was used; open surgery was performed in the other cases. Both open and laparoscopic surgeries had a similar rate of postoperative complications. Compared to laparoscopy, the open approach sometimes required longer hospital stays (97 hours vs 64 hours). Patients with appendicular perforation or abscess had 1.37- and 1.33-fold higher chance of requiring to stay in the hospital for more than 72 hours, respectively. There were found to be 3.83 and 8.33 times higher odds for the same patients to be readmitted within 28 days of surgery due to complications. Conclusion: Appendicular perforation or abscess occurs in every fourth child. A raised CRP at admission highly predicted the complicated appendicitis. Complicated appendicitis consistently increases hospital stay and readmission rates. Postoperative complication rates are more or less the same with either open or laparoscopy except for the duration of the hospital stay (more in open surgery).