The treatment of complicated appendicitis in children. What is the gold standard?
J. R. Elmore, A. W. Dibbins and M. R. Curci
From 1976 to 1985, 233 consecutive children were treated for appendicitis
by a standardized protocol. Forty-nine percent of these cases were
complicated: 11% by gangrene, 33% by perforation, and 4% by perforations
with well-developed abscesses. Treatment of gangrenous and perforated
appendicitis consisted of administration of ampicillin sodium, gentamicin
sulfate, and clindamycin phosphate; appendectomy; and saline peritoneal
irrigation. Transperitoneal drainage was not used. Skin and subcutaneous
tissues were left open for delayed primary wound closure. Perforations with
well-developed abscesses were treated with triple antibiotic therapy and
interval appendectomy. The only infectious complication was one
intra-abdominal abscess. There were no wound infections or deaths. The rate
of infectious complications was 0.9%, and the overall morbidity was 4.4%.
This standardized treatment of complicated appendicitis in children
prevents wound infection and significantly decreases the incidence of
intra-abdominal abscess formation and mortality.
