Aggressive approach to complicated appendicitis in children

  Objective(s): Appendicitis remains the most common condition in the pediatric population requiring emergency abdominal operation. Management of acute simple appendicitis is well described but controversy remains as to the optimal treatment of complicated appendicitis. Common complications of acute appendicitis include: localized peritonitis and abscess formation, flegmon and general peritonitis.   Methods: In this prospective study we have evaluated the results of aggressive therapy in management of complicated appendicitis in children in Sarvar pediatric hospital of Mashhad, Iran.   Results: Among 60 children with acute complicated appendicitis male to female ratio was 4:1 and mean age was 7.18±2.17 years. 60% were operated via low mid line incision and 40% by Rocky Davis incision. The most common final diagnosis was appendicular abscess that was observed in 34 patients. Primary wound closure was performed in 96.7% and placement of drain in peritoneal cavity in right lower quadrant was done only in 13.3%. Safe appendectomy was performed in all 60 cases and post operative complications included two cases with wound infection and 4 cases with Chronic abdominal pain that were managed conservatively. Only one patient was re admitted and underwent re-laparotomy because of bowel obstruction.   Conclusions: according to our findings the current non operative approach to complicated appendicitis in children needs a revision.