Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial successful non-operative management of uncomplicated appendicitis in pediatric patients

Koike, Yuhki; Uchida, Keiichi; Matsushita, Kohei; Otake, Kohei; Nakazawa, Makoto; Inoue, Mikihiro; Kusunoki, Masato; Tsukamoto, Youichi

doi:10.1016/j.jpedsurg.2014.01.003

Cited by 54 publications

(41 citation statements)

References 27 publications

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“…Based on published international studies which identified several risk factors for failure of nonoperative management [2][3][4][5][6], we performed our first study investigating the feasibility of nonoperative management in children using very narrow inclusion criteria to minimize potential harm [1]. The most common reason for exclusion of patients in that trial was the presence of an appendicolith on imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Among studies comparing patients undergoing nonoperative management versus surgery, nonoperative management fails in 19%-40% of patients [1][2][3][4][5][6]. Studies which used more conservative inclusion criteria, such as lower white blood cell count thresholds, shorter duration of pain prior to presentation, and absence of phlegmon or abscess on imaging, report lower failure rates of nonoperative management [1][2][3][4].…”

mentioning

confidence: 99%

“…Studies which used more conservative inclusion criteria, such as lower white blood cell count thresholds, shorter duration of pain prior to presentation, and absence of phlegmon or abscess on imaging, report lower failure rates of nonoperative management [1][2][3][4]. Identifying factors associated with failure of nonoperative management is important to allow for better patient selection to minimize potential harm.…”

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confidence: 99%

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High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

Mahida

Lodwick

Nacion

et al. 2016

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

Mahida

Lodwick

Nacion

et al. 2016

Journal of Pediatric Surgery

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“…Only one study addressed clinical recovery by reporting on abdominal pain. In 125 children who were treated non-operatively, the median period to disappearance of abdominal pain was 2.12 days [23]. Comparisons with standard appendectomy have not been made [23].…”

Section: Discussionmentioning

confidence: 99%

Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study

et al. 2018

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Non-operative treatment of uncomplicated appendicitis in children is gaining ground. Pending definitive evidence regarding its effectiveness, there is a call to evaluate clinical recovery after non-operative treatment. In this study, we analyzed data collected during initial admission of a multicenter prospective cohort in which children, 7–17 year, were treated non-operatively for uncomplicated appendicitis. During admission clinical parameters (pain and gastro-intestinal symptoms), inflammation parameters and sequential abdominal ultrasound were recorded. In total, 45 children were included, 42(93%) were discharged without the need for appendectomy; median [IQR] pain scores on admission were 5 [4–7], decreasing to 2 [0–3] after 1 day of treatment. Initially, 28/42 (67%) reported nausea and 19/42 (45%) vomiting; after 1 day, this was 3/42 (7%) and 1/42 (2%), respectively. White blood cell count declined from a median [IQR] of 12.9 [10.7–16.7] 10E9/L on admission to 7.0 [5.8–9.9] 10E9/L on day 1. Median [IQR] C-reactive protein levels increased from 27.5 [9–69] mg/L on admission to 48 [22–80] mg/L on day 1, declining to 21.5 [11–42] mg/L on day 2. Follow-up ultrasound showed no signs of complicated appendicitis in any of the patients.Conclusion: Clinical symptoms resolved in most children after 1 day of non-operative treatment. This suggests that non-operative treatment is a viable alternative to appendectomy regarding clinical recovery.Trail registration: NCT01356641 What is Known: • Non-operative treatment of uncomplicated appendicitis in children is safe and its use around the world is gaining ground, however high quality evidence from adequately designed randomized trials is still lacking.• Concerns have been raised regarding the potentially prolonged clinical recovery associated with non-operative treatment. What is New: • Most clinical symptoms resolve after 1 day of non-operative treatment in the majority of children.Electronic supplementary materialThe online version of this article (10.1007/s00431-018-3277-9) contains supplementary material, which is available to authorized users.

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“…Ultrasonography of the pediatric gastrointestinal tract can result in morbidity from an associated complication such as appendiceal rupture or bowel obstruction [53,54] . Non-operative management of acute uncomplicated appendicitis in children is also used in select cases [55,56] . Symptoms of acute appendicitis are variable and can include periumbilical and/or right lower quadrant pain, anorexia, nausea, fever, and leukocytosis [54,57] .…”

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confidence: 99%

Abdominal ultrasonography of the pediatric gastrointestinal tract

Gale¹,

Gee²,

Westra³

et al. 2016

WJR

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Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.

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Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial successful non-operative management of uncomplicated appendicitis in pediatric patients

Cited by 54 publications

References 27 publications

High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study

Abdominal ultrasonography of the pediatric gastrointestinal tract

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