Non-operative Management of Pediatric Appendicitis With an Appendicoltih

Non-operative Management of Uncomplicated Appendicitis With an Appendicolth in Children

To determine if non-operative management with antibiotics alone is a feasible treatment alternative for pediatric patients with uncomplicated acute appendicitis with an appendicolith identified on imaging.

This study is a prospective randomized clinical trial comparing non-operative management with antibiotics to urgent appendectomy in children (ages 7-17yrs) with acute appendicitis with the presence of an appendicolith. Enrolled participants were followed up to 1 year post-discharge to observe the rates of appendicitis recurrence as well as identify the number of patients with complicated appendicitis as determined by pathologic examination.

Inclusion Criteria:

• Age : 7-17 years

• Abdominal pain </= 48hours prior to receiving antibiotics

• White Blood Cell Count >5 but < 18

• US or CT confirmed early appendicitis plus:

  • US: </=1.1 cm in diameter, presence of appendicolith
  • CT: </= 1.1cm in diameter, presence of appendicolith

Exclusion Criteria:

• Positive urine pregnancy test
• Pain > 48 hours prior to first antibiotic dose
• Diffuse peritonitis
• History of chronic intermittent abdominal pain
• White Blood Cell count ≤ 5 or ≥ 18
• Absence of appendicolith or any evidence on imaging studies concerning for evolving perforated appendicitis including abscess or phlegmon