Follow-up study On timing, clinical manifestations, predictors of re-inflammation of the appendix, and choice of treatment tactics in children

BACKGROUND: Reports of successful conservative treatment of acute appendicitis in children demonstrate the effectiveness of primary treatment in 89%–97% of cases. Data for evaluating outcomes with a follow-up period of more than 5 years are available. AIM: This study aimed to develop techniques for the follow-up observation of children after regression of inflammation in the appendix and for re-inflammation by establishing the prevailing timing and possible predictors of relapse. MATERIALS AND METHODS: The study was based on the results of a follow-up observation of 92 patients who had previously received medical care until October 2023 because of an episode of inflammation in the appendix with regression. The disease was diagnosed using the pediatric appendicitis score and ultrasound. Thirteen children underwent appendectomy without therapy. Conservative treatment was performed in eight patients, which was ineffective in four (50%) of them, who also required appendectomy. RESULTS: The patients were divided into two main groups: with relapse of inflammation in the appendix (20 patients, 21.7%) and without relapse (72 children, 78.2%). The relapse rate was 21.7% (20 of 92 children), cumulative disease-free survival was 49.3 ± 8.6%, and surgical-free survival was 54.3 ± 8.7%. A comparative analysis of clinical, laboratory, and ultrasonographic data obtained during the first episode of inflammation did not reveal reliable predictors of relapse (p 0.28). The duration of observation in patients without relapse ranged from 1 to 74 months (median: 36 [LQ 25; UQ 54] months). In 25 (34.7%) of them, the observation was interrupted owing to reaching the age of 18 years, over a follow-up period from 1 to 70 months (26 [LQ 15; UQ 38] months). CONCLUSIONS: Data demonstrate a relatively low occurrence of relapses of inflammation of the appendix after effective conservative treatment. The study did not reveal any significant predictors of an increased risk of relapse. Conservative therapy for recurrent inflammation can be conducted; however, it is less effective than for the primary episode.