SS  Vol.2 No.2 , April 2011
The Presence but not the Location of an Appendicolith Affects the Success of Interval Appendectomy in Children with Ruptured Appendicitis
Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of pediatric patients presenting with ruptured appendicitis was performed. Patients in whom the intent to treat was with initial non-operative management and interval appendectomy (IA) were selected (n = 117). One patient was excluded due to the presence of both intraluminal and extraluminal appendicoliths. Children who failed initial non-operative management were assigned to the “failure” group (n = 22). Children that improved and underwent elective IA were assigned to the “success” group (n = 94). Age, gender, duration of symptoms, presence of an appendicolith, appendicolith location (intraluminal/extraluminal), presence of a drainable abscess, and complications were reviewed. Results: There was an overall 18.8% failure rate for IA. Patients with an appendicolith had a 41.7% failure rate, and patients without an appendicolith had a 13% failure rate (p = 0.003). Patients with intraluminal or extraluminal appendicoliths each had a 41.7% failure rate. The presence or absence of a drainable in-tra-abdominal abscess did not affect the failure rate. Children in the failure group presented to the hospital earlier (6.57 ± 2.59 vs. 10.02 ± 7.21 days; p = 0.030). Conclusions: The presence of an appendicolith increases the likelihood of failure of initial non-operative management of ruptured appendicitis in children; however, the location of the appendicolith is not a predictor of failure.

Cite this paper
nullI. James, S. Druhan, D. Caniano and G. Besner, "The Presence but not the Location of an Appendicolith Affects the Success of Interval Appendectomy in Children with Ruptured Appendicitis," Surgical Science, Vol. 2 No. 2, 2011, pp. 39-44. doi: 10.4236/ss.2011.22009.
[1]   C. Chen, C. Botelho, A. Cooper, P. Hibberd and S. K. Parsons, “Current Practice Patterns in the Treatment of Perforated Appendicitis in Children,” Journal of the American College of Surgeons, Vol. 196, No. 2, February 2003, pp. 212-221. doi:10.1016/S1072-7515(02)01666-6

[2]   M. C. W. Henry, G. Gollin, S. Islam, K. Sylvester, A. Walker, B. L. Silverman and R. Lawrence Moss, “Matched Analysis of Nonoperative Management Vs Immediate Appendectomy for Perforated Appendicitis,” Journal of Pediatric Surgery, Vol. 42, No. 1, January 2007, pp. 19-24. doi:10.1016/j.jpedsurg.2006.09.005

[3]   T. R. Weber, M. A. Keller, R. J. Bower, G. Spinner and K. Vierling, “Is Delayed Operative Treatment Worth the Trouble with Perforated Appendicitis in Children?” The American Journal of Surgery, Vol. 186, No. 6, December 2003, pp. 685-689. doi:10.1016/j.amjsurg.2003.08.027

[4]   D. W Vane and N. Fernandez, “Role of Interval Appendectomy in the Management of Complicated Appendicitis in Children,” World Journal of Surgery, Vol. 30, No. 1, January 2006, pp. 51-54. doi:10.1007/s00268-005-7946-2

[5]   M. Samuel, G. Hosie, and K. Holmes, “Prospective Evaluation of Nonsurgical Versus Surgical Management of Appendiceal Mass,” Journal of Pediatric Surgery, Vol. 37, No. 6, June 2002, 882-886. doi:10.1053/jpsu.2002.32895

[6]   D. Puapong, S. L. Lee, P. I. Haigh, A. Kaminski, I. L. Liu and H. Applebaum, “Routine Interval Appendectomy in Children Is Not Indicated.” Journal of Pediatric Surgery, Vol 42, No. 5, May 2007, pp. 1500-1503. doi:10.1016/j.jpedsurg.2007.04.011

[7]   I. Karaca, Z. Altintoprak, A. Karkiner, G. Temir and E. Mir, “The Management of Appendiceal Mass in Children: Is Interval Appendectomy Necessary?” Surgery Today, Vol. 31, No. 8, August 2001, pp. 675-677. doi:10.1007/s005950170068

[8]   S. H. Ein and B. Shandling B, “Is Interval Appendectomy Necessary after Rupture of an Appendiceal Mass?” Journal of Pediatric Surgery, Vol. 31, No. 6, June1996, pp. 849-850. doi:10.1016/S0022-3468(96)90151-7

[9]   R. E. Andersson and M. G. Petzold, “Nonsurgical Treatment of Appendiceal Abscess or Phlegmon: A Systemic Review And Meta-Analysis,” Annals of Surgery, Vol. 246, No. 5, November 2007, pp. 741-s748. doi:10.1097/SLA.0b013e31811f3f9f

[10]   S. H. Ein, J. C. Langer and A. Daneman, “Nonoperative Management of Pediatric Ruptured Appendix with Inflammatory Mass or Abscess: Presence of an Appendico- lith Predicts Recurrent Appendicitis,” Journal of Pediat- ric Surgery, Vol. 40, No. 10, October 2005, pp. 1612- 1615. doi:10.1016/j.jpedsurg.2005.06.001

[11]   C. J. Aprahamian, D. C. Barnhart and S. E. Bledsoe, “Failure in The Nonoperative Management of Pediatric Ruptured Appendicitis: Predictors and Consequences,” Journal of Pediatric Surgery, Vol. 42, No. 6, June 2007, pp. 934-938. doi:10.1016/j.jpedsurg.2007.01.024.

[12]   J. Gillick, M. Velayudham and P. Puri, “Conservative Management of Appendix Mass in Children” British Journal of Surgery, Vol. 88, No. 11, November 2001, pp. 539-542.

[13]   E. P. Nadler, K. K. Reblock and K. G. Vaughan, “Predictors of Outcome for Children with Perforated Appendicitis Initially Treated with Non-Operative Management,” Surgical Infections, Vol. 5, No. 4, Winter 2004, pp. 349-356. doi:10.1089/sur.2004.5.349

[14]   T. Levin, C. Whyte, R. Borzykowski, B. Han, N. Blitman and B. Harris, “Nonoperative Management of Perforated Appendicitis in Children: Can CT Predict Outcome?” Pediatric Radiology, Vol. 37, No. 3, March 2007, pp. 251-255. doi:10.1007/s00247-006-0384-y

[15]   S. G. Muehlstedt, T. Q. Pham and D. J. Schmeling, “The Management of Pediatric Appendicitis: A Survey of North American Pediatric Surgeons,” Journal of Pediatric Surgery, Vol. 39, No. 6, June 2004, pp. 875- 859. doi:10.1016/j.jpedsurg.2004.02.035

[16]   P. Poortman P, P. N. M. Lohle, C. M. C Schoemaker, H. J Oostvogel, H. J. Teepen, K. A. Zwinderman and J. F. Hamming, “Comparison of CT and Sonography in the Diagnosis of Acute Appendicitis: A Blinded Prospective Study,” American Journal of Roentgenology, Vol. 181, No. 5, November 2003, pp. 1355-1359.

[17]   T. E. Monfore and F. J. Montegut, “The Case of the Missing Fecalith,” Archives of Surgery, Vol. 86, No. 4, April 1963, pp. 655- 658.

[18]   M. Mulder, “Retained Fecalith as Late Complication of Appendectomy,” Journal of American Medica Association, Vol. 225, No. 6, August 1973, pp. 639.

[19]   N. Fraser, C. Gannon and M. D.Stringer, “Appendicular Colic and the Non-Inflamed Appendix: Fact or Fiction?” European Journal of Pediatric Surgery, Vol. 14, No. 1, February 2004, pp. 21-24.