Outcomes of early surgical management of complicated appendicitis in children

Abstract

Background: Appendicitis is the most common surgical emergency in children. Nearly 30% of children present with complicated appendicitis. Controversy exists between early or delayed surgery in complicated appendicitis. Present study was done to evaluate the outcome of early surgical management of complicated appendicitis in children and also to analyze risk factors for complicated appendicitis.Methods: A retrospective observational study conducted by the department of Paediatric Surgery, KIMS, hospital Bangalore. All children with complicated appendicitis (perforated, gangrenous and mass) from October 2014 to October 2017 were included in the study. Clinical, biochemical and imaging findings of these children were tabulated. Children underwent either open or laparoscopic appendectomy. Intra operative data regarding the type of complication, presence or absence of Fecolith, position of appendix was documented. Post operatively duration of stay and complications were analyzed.Results: 47 children were included in the study. Mean age of presentation was 10.38±2.84 years. Most common presentation was pain abdomen. 65% of the patient had pain abdomen for duration of three days or more. Total leucocyte count of more than 15000 was seen in about 50% of the children. 68% of children underwent laparotomy, 23.5% underwent laparoscopic appendectomy. Intra operatively, perforation of the appendix with generalized peritonitis was the commonest finding. Fecolith was present in 32% of the cases. Mean duration of stay was 7.46 days. Wound infection was seen in 15% of the children. Late complication in the form of adhesive obstruction was seen in 5 patients.Conclusions: Complicated appendicitis is associated with high morbidity. High leucocyte count, delayed presentation and Fecolith are possible indicators of complicated appendicitis. Early surgery in complicated appendicitis is safe, feasible. The complication rate is acceptable and most of them can be managed conservatively. Hence early surgery in complicated appendicitis is an option to be considered.