Abstract
Diagnosis of appendicitis is sometimes difficult because of atypical presentation. Our strategy for children with suspected appendicitis consists of (1) immediate appendectomy after diagnosis and (2) a conservative approach to make a diagnosis with repeated careful physical examinations without antibiotics after admission along with diagnostic ultrasonography (US) if available. A retrospective review of 345 consecutive children with suspected appendicitis treated with our conservative management demonstrated that the rate of negative appendectomies were 19/212 (9.0%) in all patients and 5/125 (4.5%) in those with US studies. Our data also suggested that the appendicitis had resolved spontaneously at least in 21 out of 125 patients with significant morphologic changes seen on US imaging. We conclude that reliable diagnostic US could improve the accuracy of the diagnosis by imaging the pathologic changes. However, bearing the possibility of spontaneously resolving appendicitis in mind, careful repeated physical examinations by experienced clinicians along with imaging studies can minimize unnecessary appendectomies in children.
