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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2020; 12(4): 129-137
Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.129
Management of complicated acute appendicitis in children: Still an existing controversy
Nick Zavras, George Vaos
Nick Zavras, George Vaos, Department of Paediatric Surgery, “ATTIKON” University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 12462, Greece
Author contributions: Zavras N designed the protocol, analyzed the data and wrote the manuscript; Vaos G conceived the idea, wrote and revised the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: George Vaos, MD, PhD, Emeritus Professor, FEBPS, Department of Paediatric Surgery, “ATTIKON” University General Hospital, National and Kapodistrian University of Athens, School of Medicine, 1 Rimini Street, Haidari, Athens 12462, Greece. gvaos@med.uoa.gr
Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: February 19, 2020
Revised: March 15, 2020
Accepted: March 28, 2020
Article in press: March 28, 2020
Published online: April 27, 2020
Processing time: 113 Days and 14.5 Hours
Abstract

Complicated acute appendicitis (CAA) is a serious condition and carries significant morbidity in children. A strict diagnosis is challenging, as there are many lesions that mimic CAA. The management of CAA is still controversial. There are two options for treatment: Immediate operative management and non-operative management with antibiotics and/or drainage of any abscess or phlegmon. Each method of treatment has advantages and disadvantages. Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events. In many cases, non-operative management with or without drainage and interval appendectomy is advised. The reasons for this approach include new medications and policies for the use of antibiotic therapy. Furthermore, advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries. However, questions have been raised about the risk of recurrence, prolonged use of antibiotics, lengthened hospital stay and delay in returning to daily activities. Moreover, the need for interval appendectomy is currently under debate because of the low risk of recurrence. Due to the paucity of high-quality studies, more randomized controlled trials to determine the precise management strategy are needed. This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.

Keywords: Complicated acute appendicitis; Operative treatment; Non-operative treatment; Antibiotics; Children

Core tip: The management of paediatric patients with complicated acute appendicitis (CAA) is controversial. There are two options for treatment: non-operative management with antibiotics and/or drainage of any abscess or phlegmon and immediate operative management. Each method has advantages and disadvantages. However, operative management is suggested for CAA with perforation, while non-operative management is advised for CAA with abscess or phlegmon. There is a paucity of high-quality studies in the current literature. Further investigations with randomized control studies are warranted.