Non-operative management of early, acute appendicitis in children: Is it safe and effective?

Abstract Purpose The purpose of this study was to determine if early, acute appendicitis in children can be safely and effectively managed with antibiotics alone. Methods A retrospective review was performed of children ( Results Twelve patients (66% female, mean age 12.2,SD=4.2yrs) were treated non-operatively, while 12 (50% female, mean age 12.5,SD=3.2yrs) were treated operatively. Two NOM children (16.7%) required initial appendectomy. One patient developed recurrent appendicitis requiring appendectomy 7months post-discharge. Four other NOM patients returned with symptoms but did not require admission or surgery. Two OM patients (8.3%) had hospital visits and admissions related to surgical site infections. Mean length of stay (LOS) for the first visit was 1.5days (SD=1.0d) (NOM) vs. 1.3days (SD=0.5d) (OM) (p=0.61). Including first and subsequent admissions, mean LOS was 1.8days (SD=1.1d) (NOM) vs. 1.7days (SD=1.5d) (OM) (p=0.97). Conclusion Early acute appendicitis in appropriately selected children can be successfully treated non-operatively. Randomized trials with longer follow-up are required.