Indication for Conservative Treatment and Its Potential as an Outpatient Treatment for Uncomplicated Appendicitis in Children

Abstract

Purpose: We investigated the indications for conservative treatment and its potential as an outpatient treatment for uncomplicated appendicitis in children.

Methods: One hundred sixty-eight children were diagnosed with acute uncomplicated appendicitis by computed tomography between January 2007 and December 2017. Conservative treatment was performed as primary treatment in 86 of the 168 patients. We referred to the patients’ medical records and retrospectively investigated the indications for conservative treatment.

Results: The mean age was 10.8 years, and 48 were inpatients whereas 38 were outpatients. The mean duration of hospital admission among the inpatients was 4.6 days. Surgery was performed in 3 patients (3.5%) because conservative treatment was not effective. The treatment success rate was 96% for the inpatients and 97% for the outpatients. Appendicitis recurred in 8 (9.6%) of the 83 patients who responded well to initial conservative treatment. The mean time to recurrence after conservative treatment was 4.4 months. At recurrence, surgery was performed in 5 patients, 3 of whom received repeat conservative treatment followed by elective appendectomy. Interval appendectomy was performed in 7 of the 75 patients who had no recurrence, and appendectomy was eventually performed in 15 (18.1%) of these 83 patients. The remaining 68 patients (81.9%) had no recurrence and are currently being observed.

Conclusions: The response rate for conservative treatment is high in children with uncomplicated appendicitis. The outcomes of antibiotic treatment are good for outpatients. Our findings suggest that antibiotic treatment may be a safe and efficacious therapeutic option for the treatment of acute uncomplicated appendicitis in children.