Early appendectomy for perforated appendicitis in children should not be abandoned

Abstract

Appendectomy for the diagnosis of appendicitis was prospectively performed upon 133 children from 1 July 1982 to 30 June 1985 with no mortality. The pathologic diagnosis revealed 11 normal appendices (8.3 per cent), 54 instances of acute appendicitis (40.6 per cent), 16 instances of gangrenous appendicitis (12.0 per cent) and 52 instances of perforated appendicitis (39.1 per cent). There were no complications in those patients with normal appendices, acute appendicitis and gangrenous appendicitis and the mean length of hospitalization for these groups was 3.27, 3.37 and 4.75 days, respectively. The mean length of hospitalization for patients with perforated appendicitis was significantly longer, 9.45 days (p less than 0.05). Thirteen complications developed in 11 patients with perforated appendicitis. Eight patients required a reoperation (a major morbidity rate of 15.4 per cent). There was only one readmission which occurred three and one-half weeks after discharge for intestinal obstruction. Early appendectomy in children with a presumed diagnosis of either acute or perforated appendicitis resulted in low morbidity rates and is more cost effective than nonoperative management proposed by others due to shorter hospitalization and no planned readmission.