Management of perforated appendicitis in children--revisited
S. L. Samelson and H. M. Reyes
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.
