Factors associated with failure of nonoperative treatment of complicated appendicitis in children

Talishinskiy, Toghrul; Limberg, Jessica; Ginsburg, Howard B.; Kuenzler, Keith A.; Fisher, Jason C.; Tomita, Sandra

doi:10.1016/j.jpedsurg.2016.01.006

Cited by 25 publications

(18 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Success of non-operative management has been well documented in numerous studies. 61 , 70 , 77 – 93 Some studies specify the presence of a mass or discrete abscess in the description of perforated appendicitis and non-operative management. 77 – 88 Successful treatment has been seen with drainage 76 , 81 , 87 , 94 – 96 and no drainage 77 , 88 , 97 of abscesses.…”

Section: Managementmentioning

confidence: 99%

“…Other studies highlight the success of non-operative management and do not make a distinction regarding the presence of mass or discrete abscess. 61 , 70 , 89 – 93 Documented benefits include decreased morbidity, 68 , 70 , 80 , 81 , 86 , 89 , 90 , 96 , 98 shorter LOS, 70 , 84 , 99 lower costs, 71 , 84 , 89 improved quality of life, 71 and fewer days off. 71 …”

Section: Managementmentioning

confidence: 99%

“… 33 , 71 , 100 , 103 , 109 , 110 , 115 Although this is the most commonly cited reason for failure of non-operative management, Talishinskiy et al found appendicolith was not predictive of non-operative failure in their retrospective review of 64 cases of pediatric perforated appendicitis. 93 Zhang et al found that most appendicoliths resolve and that the presence of a persistent appendicolith was more predictive of failing non-operative management. 83 Nazarey et al reviewed 105 pediatric perforated appendicitis cases managed non-operatively and found the combination of an appendicolith plus leukocytosis greater than 15,000 white blood cells (WBC) per microliter was associated with treatment failure.…”

Section: Managementmentioning

confidence: 99%

See 2 more Smart Citations

Perforation risk in pediatric appendicitis: assessment and management

Howell

Dubina

Lee

2018

PHMT

View full text Add to dashboard Cite

Perforated appendicitis, as defined by a visible hole in the appendix or an appendicolith free within the abdomen, carries significant morbidity in the pediatric population. Accurate diagnosis is challenging as there is no single symptom or sign that accurately predicts perforated appendicitis. Younger patients and those with increased duration of symptoms are at higher risk of perforated appendicitis. Elevated leukocytosis, bandemia, high C-reactive protein, hyponatremia, ultrasound, and CT are all useful tools in diagnosis. Distinguishing patients with perforation from those without is important given the influence of a perforation diagnosis on the management of the patient. Treatment for perforated appendicitis remains controversial as several options exist, each with its indications and merits, illustrating the complexity of this disease process. Patients may be managed non-operatively with antibiotics, with or without interval appendectomy. Patients may also undergo appendectomy early in the course of their index hospitalization. Factors known to predict failure of non-operative management include appendicolith, leukocytosis greater than 15,000 white blood cells per microliter, increased bands, and CT evidence of disease beyond the right lower quadrant. In this review, the indications and benefits of each treatment strategy will be discussed and an algorithm to guide treatment decisions will be proposed.

show abstract

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Perforation risk in pediatric appendicitis: assessment and management

Howell

Dubina

Lee

2018

PHMT

View full text Add to dashboard Cite

show abstract

“…Non-surgical treatment has been shown to be unsuccessful in 7.2% of patients with appendiceal abscess and phlegmon in review studies 5,6) . Furthermore, some patients had to undergo an operation earlier than initially planned due to intractable infection 7) . These unsuccessful outcomes are associated with an increased complication rate and longer length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies examined this particular sub-set of failed non-surgical management in children and reported several predictors that affect negative outcomes, which include the following: presence of an abscess rather than phlegmon 8) , appendicolith 9) , and small bowel obstruction 7,9) . However, their results are varied and disparate.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Negative Outcomes in Non-Surgical Treatment for Appendiceal Abscess in Adults

Sadakari

Date

Murakami

et al. 2018

J Anus Rectum Colon

View full text Add to dashboard Cite

Abstract:Objectives: Non-surgical treatment is an acceptable approach for managing appendiceal abscess in adults. However, it is only applicable for selected patients, and conversion to surgery is mandatory for failed conservative treatment. This study aimed to determine the predictive factors for unsuccessful outcomes. Methods: Of 594 patients with acute appendicitis, 34 (5.7%) diagnosed with appendiceal abscess were initially treated conservatively. Patients were divided into two groups: the conservative group, which was successfully treated with antibiotics and percutaneous abscess drainage, and the conversion group, which comprised patients who had surgical conversion despite conservative treatment. Risk factors for the conversion group were investigated by comparing clinical and radiological parameters between the two groups. Results: Eight (23.4%) patients were converted to surgical management at an average of 5.5 days of non-surgical treatment. An abscess size greater than 40 mm and a lower rate of improvement in the white blood cell (WBC) count were significant factors for predicting conversion in multivariate analysis. The conversion group had a long operative time and high morbidity and operative conversion rates (change of proposed initial operation). Early conversion to operation group, i.e., less than 5 days of treatment, contributed to a significantly shorter hospital stay, lower hospital cost, and relatively shorter operative time (p = 0.02, p = 0.04, and p = 0.11, respectively). Conclusions: Contributing factors in predicting unsuccessful outcomes for nonsurgical treatment include an abscess size greater than 40 mm and a low rate of improvement in WBC count on the first day of antibiotic treatment.

show abstract

Non-operative Management of Complicated Appendicitis

Dubina

Lee

2019

Controversies in Pediatric Appendicitis

View full text Add to dashboard Cite

Factors associated with failure of nonoperative treatment of complicated appendicitis in children

Cited by 25 publications

References 16 publications

Perforation risk in pediatric appendicitis: assessment and management

Perforation risk in pediatric appendicitis: assessment and management

Prediction of Negative Outcomes in Non-Surgical Treatment for Appendiceal Abscess in Adults

Non-operative Management of Complicated Appendicitis

Contact Info

Product

Resources

About