For many years, immediate surgery has been considered the only proper treatment for appendicitis in children. Now a small study suggests that in some cases, antibiotics alone may be better.
The study, published online in The Journal of the American College of Surgeons, involved 77 uncomplicated cases of acute appendicitis that met specific criteria. Patients were 7 to 17 years old; they had had pain for 48 hours or less; their white blood cell counts were only moderately elevated (less than 18,000); CT or ultrasound scans confirmed their appendix had not ruptured; and they had no impacted feces.
Thirty of the patients opted not to have immediate surgery and were treated with a minimum of 24 hours of intravenous antibiotics, followed by about a week of oral antibiotics. Any child who did not get better within 24 hours of antibiotics underwent surgery.
Of the 30, two needed surgery within 24 hours, and a third underwent surgery a day after discharge because of insufficient improvement, but none suffered complications. The other 27 nonsurgical patients missed fewer days of school and resumed normal activities sooner than those who had had appendectomies.
“It’s so dogmatic to operate for appendicitis that it requires a huge paradigm shift,” said the senior author, Dr. Katherine J. Deans, an assistant professor of surgery at Nationwide Children’s Hospital. “But there are choices. It may be safe to wait.”