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Article
April 1987

The Treatment of Complicated Appendicitis in ChildrenWhat Is the Gold Standard?

Author Affiliations

From the Department of Surgery, Maine Medical Center, Portland.

Arch Surg. 1987;122(4):424-427. doi:10.1001/archsurg.1987.01400160050006
Abstract

• From 1976 to 1985, 233 consecutive children were treated for appendicitis by a standardized protocol. Forty-nine percent of these cases were complicated: 11% by gangrene, 33% by perforation, and 4% by perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of administration of ampicillin sodium, gentamicin sulfate, and clindamycin phosphate; appendectomy; and saline peritoneal irrigation. Transperitoneal drainage was not used. Skin and subcutaneous tissues were left open for delayed primary wound closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. The only infectious complication was one intra-abdominal abscess. There were no wound infections or deaths. The rate of infectious complications was 0.9%, and the overall morbidity was 4.4%. This standardized treatment of complicated appendicitis in children prevents wound infection and significantly decreases the incidence of intra-abdominal abscess formation and mortality.

(Arch Surg 1987;122:424-427)

References
1.
Fitz R, cited by Williams GR:  A history of appendicitis . Ann Surg 1983;197:495-506.Article
2.
Ochsner AJ:  The cause of diffuse peritonitis complicating appendicitis and its prevention . JAMA 1901;36:1747-1754.Article
3.
Longino AL, Aller TM, Gross RE:  Appendicitis in childhood . Pediatrics 1958;22:238-246.
4.
Boles ET, Ireton RJ, Clatworthy HW:  Acute appendicitis in children . Arch Surg 1959;79:447-454.Article
5.
Shandling B, Ein SH, Simpson JS, et al:  Perforating appendicitis and antibiotics . J Pediatr Surg 1974;9:79-83.Article
6.
Weinstein WM, Onderdonk AB, Bartlett JG, et al:  Antimicrobial therapy of experimental intra-abdominal sepsis . J Infect Dis 1975;132:282-286.Article
7.
Onderdonk AB, Weinstein WM, Sullivan NM, et al:  Experimental intra-abdominal abscesses in rats: Quantitative bacteriology of infected animals . Infect Immun 1974;10:1256-1259.
8.
Brook I:  Bacterial studies of peritoneal cavity and postoperative surgical wound drainage following perforated appendix in children . Ann Surg 1980;192:208-212.Article
9.
David IB, Buck JR, Filler RM:  Rational use of antibiotics for perforated appendicitis in childhood . J Pediatr Surg 1982;17:494-500.Article
10.
Schwartz MZ, Tapper D, Solenberger RI:  Management of perforated appendicitis in children . Ann Surg 1983;197:407-411.Article
11.
Karp MP, Caldarola VA, Cooney DR, et al:  The avoidable excesses in the management of perforated appendicitis in children . J Pediatr Surg 1986;21:506-510.Article
12.
Haller JA, Shaker IJ, Donahoo JS, et al:  Peritoneal drainage versus non-drainage for generalized peritonitis from ruptured appendicitis in children . Ann Surg 1973;177:595-600.
13.
Fowler R:  A controlled trial of intraperitoneal cephaloridine administration in peritonitis . J Pediatr Surg 1975;10:43-50.Article
14.
Sherman JO, Luck SR, Borger JA:  Irrigation of the peritoneal cavity for appendicitis in children: A double-blind study . J Pediatr Surg 1976;11: 371-374.Article
15.
Grosfeld JL, Solit RW:  Prevention of wound infection in perforated appendicitis: Experience with delayed primary wound closure . Ann Surg 1968;168:891-895.Article
16.
Stone HH, Sanders SL, Martin JD:  Perforated appendicitis in children . Surgery 1971;69:673-679.
17.
Birken GA, Schropp KP, Boles ET, et al:  Discharge planning for children with perforated appendicitis . J Pediatr Surg 1986;21:592-595.Article
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