• Appendicitis
• Complicated appendicitis
• Interval appendectomy
• Non operative management
• Postoperative complications

• Humans
• Appendicitis/surgery
• Appendicitis/therapy
• Appendicitis/complications
• Appendectomy
• Risk Factors
• Treatment Failure
• Male
• Female
• Adult
• Middle Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Young Adult
• Aged
• Treatment Outcome
• Emergencies
• Retrospective Studies
• Leukocyte Count

• appendicitis
• complicated appendicitis
• morbidity
• mortality
• uncomplicated appendicitis

• Appendectomy
• Appendiceal abscess
• Appendiceal mass
• Appendicitis
• Children
• Non-operative treatment

• Abscess/surgery
• Adolescent
• Appendectomy/methods
• Appendicitis/surgery
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Prospective Studies
• Risk

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.

• Complicated acute appendicitis
• Operative treatment
• Non-operative treatment
• Antibiotics
• Children

• appendicular abscess
• interval appendectomy
• non-operative management

• Appendicitis
• conservative
• operative

• appendicitis
• conservative
• complicated
• uncomplicated
• review
• adult
• children
• treatment

• Abdominal Abscess/etiology
• Adult
• Analgesics/therapeutic use
• Anti-Bacterial Agents/therapeutic use
• Appendectomy
• Appendicitis/complications
• Appendicitis/drug therapy
• Appendicitis/surgery
• Child
• Conservative Treatment/trends
• Follow-Up Studies
• Humans
• Length of Stay
• Meta-Analysis as Topic
• Multicenter Studies as Topic
• Observational Studies as Topic
• Peritonitis/drug therapy
• Peritonitis/etiology
• Randomized Controlled Trials as Topic
• Recurrence
• Treatment Outcome
• Unnecessary Procedures

Perforated appendicitis, as defined by a visible hole in the appendix or an appendicolith free within the abdomen, carries significant morbidity in the pediatric population. Accurate diagnosis is challenging as there is no single symptom or sign that accurately predicts perforated appendicitis. Younger patients and those with increased duration of symptoms are at higher risk of perforated appendicitis. Elevated leukocytosis, bandemia, high C-reactive protein, hyponatremia, ultrasound, and CT are all useful tools in diagnosis. Distinguishing patients with perforation from those without is important given the influence of a perforation diagnosis on the management of the patient. Treatment for perforated appendicitis remains controversial as several options exist, each with its indications and merits, illustrating the complexity of this disease process. Patients may be managed non-operatively with antibiotics, with or without interval appendectomy. Patients may also undergo appendectomy early in the course of their index hospitalization. Factors known to predict failure of non-operative management include appendicolith, leukocytosis greater than 15,000 white blood cells per microliter, increased bands, and CT evidence of disease beyond the right lower quadrant. In this review, the indications and benefits of each treatment strategy will be discussed and an algorithm to guide treatment decisions will be proposed.

• diagnosis
• interval appendectomy
• management
• pediatric
• perforated appendicitis

Le but de notre étude était d’évaluer les résultats du traitement chirurgicale du plastron appendiculaire après appendicectomie différée ou immédiate. Il s’agit d’une étude rétrospective de type descriptif allant de Janvier 2000 au 31 Décembre 2007 portant sur 27 patients reçus et traités pour plastron appendiculaire. Le diagnostic était clinique par la présence d’une masse à la fosse iliaque droite, échographique, ou per opératoire. Tous les patients opérés en urgence ont été classés dans le groupe I et ceux opérés à froid, groupe II. Nous avons noté 18 hommes et 9 femmes avec un sex-ratio homme /femme = 3. L’âge moyen de nos patients était de 33 ans avec des extrêmes de 19 et 57 ans. Les signes cliniques étaient dominés par la douleur à la fosse iliaque droite et la fièvre respectivement 25 (92,6%) et 15 (55,6%) des cas. Dans le groupe I, l’appendicectomie n’a pu être réalisée pour 7 patients (n = 15) dû aux difficultés opératoires. Dans les autres cas, l’appendicectomie était possible au prix de l’élargissement de l’incision de Mac Burney et une durée de séjour plus longue. Le groupe II a concerné 12 patients (n = 12) avec 9 abords laparoscopiques et dans 3 cas, la voie de Mac Burney a été empruntée. Trois cas d’adhérences péritonéales ont été notés lors de la coelioscopie. L’appendicectomie à froid du plastron appendiculaire est un procédé sûr et efficace. Elle permet d’éviter les cicatrices inesthétiques et les fistules digestives iatrogènes. L’appendicectomie immédiate doit être abandonnée chez les patients porteurs de plastron appendiculaire car elle engendre beaucoup de morbidité.

• Plastron
• appendix
• deferred
• emergency
• treatment

In children less than 3 years of age, there is little experience in the nonoperative management of appendiceal phlegmon or abscess (APA), especially in APA with an appendicolith. The purposes of this study were to evaluate the effects of an appendicolith and the success rate of nonoperative management for APA in these young children.

Children younger than 3 years of age with APA who underwent attempted initial nonoperative treatment between January 2008 and December 2016 were reviewed. Based on the presence or absence of an appendicolith on admission ultrasonography examination or computed tomography scan, children were divided into two groups: appendicolith group and no appendicolith group.

There were 50 children who met the study criteria. Among 50 children, three children failed to respond to nonoperative treatment because of aggravated intestinal obstruction or recurrent appendicitis within 30 days of admission. The overall success rate for nonoperative management of APA was 94% (47/50) in children younger than 3 years old. The rate of diarrhea and CRP levels were higher in the appendicolith group than that of the no appendicolith group (P < 0.05). However, the success rate and the hospital length of stay for nonoperative treatment in the appendicolith group and the no appendicolith group were similar without statistical significance.

APA with or without an appendicolith can have nonoperative management without immediate appendectomy in children less than 3 years old.

• Appendiceal abscess
• Appendiceal phlegmon
• Appendicolith
• Children
• Nonoperative treatment

• Abscess/complications
• Abscess/mortality
• Abscess/surgery
• Adult
• Appendectomy/methods
• Appendectomy/mortality
• Appendicitis/complications
• Appendicitis/mortality
• Appendicitis/surgery
• Cellulitis/complications
• Cellulitis/mortality
• Cellulitis/surgery
• Child
• Conservative Treatment
• Emergencies
• Humans
• Length of Stay
• Quality of Life
• Randomized Controlled Trials as Topic
• Time-to-Treatment

• Acute Disease
• Appendectomy/methods
• Appendicitis/diagnosis
• Appendicitis/surgery
• Humans
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Magnetic Resonance Imaging
• Multimodal Imaging
• Physical Examination/methods
• Reoperation
• Tomography, X-Ray Computed
• Ultrasonography

• appendicitis
• children
• prolonged hospitalization
• risk factors

• Antibiotics
• Intra-abdominal infections
• Peritonitis
• Sepsis

• Abdominal Injuries/drug therapy
• Abdominal Injuries/surgery
• Anti-Bacterial Agents/therapeutic use
• Disease Management
• Guidelines as Topic
• Humans
• Intraabdominal Infections/drug therapy
• Intraabdominal Infections/surgery
• Organ Dysfunction Scores
• Peritonitis/drug therapy
• Sepsis/drug therapy
• Sepsis/surgery
• Societies, Medical/organization & administration
• Societies, Medical/trends
• Surgeons/organization & administration
• Surgeons/trends

In this study, we studied the therapeutic effectiveness of percutaneous drainage with antibiotics and the need for an interval appendectomy for treating appendiceal abscess in children with a research-oriented dataset released by the Bureau of National Health Insurance in Taiwan through the Collaboration Center for Health Information Application (CCHIA).

We identified 1225 patients under 18 years of age who had non-surgical treatment for an appendiceal abscess between 2007 and 2012 in a Taiwan CCHIA dataset. The treatment included percutaneous drainage with antibiotics or antibiotics alone. We also analyzed data of patient’s baseline characteristics, outcomes of percutaneous drainage, and indicating factors for performing an interval appendectomy.

Totally, 6190 children had an appendiceal abscess, an 1225 patients received non-operative treatment. Of 1225 patients, 150 patients received treatment with percutaneous drainage and antibiotics, 78 had recurrent appendicitis, 185 went on to receive an interval appendectomy, and 10 had postoperative complications after the interval appendectomy. We found that patients treated with percutaneous drainage and antibiotics had a significantly lower rate of recurrent appendicitis (p < 0.05), a significantly smaller chance of receiving an interval appendectomy (p < 0.05), and significantly fewer postoperative complications after the interval appendectomy (p < 0.05) than those without percutaneous drainage treatment. Older children (13 ~ 18 years) patients were found to have a significantly smaller need to receive an interval appendectomy than those who were ≤ 6 years of age (odd ratio (OR) = 2.071, 95 % confidence interval (CI) = 1.34–3.19, p < 0.01), and those who were 7 ~ 12 years old (OR = 1.662, 95 % CI = 1.15–2.41, p < 0.01). In addition, those treated with percutaneous drainage were significantly less indicated to receive an interval appendectomy later (OR = 2.249, 95 % CI = 1.19 ~ 4.26, p < 0.05). In addition, those with recurrent appendicitis had a significantly increased incidence of receiving an interval appendectomy later (OR = 3.231, 95 % CI = 1.95 ~ 5.35, p < 0.001).

In this study, we used nationwide data to demonstrate therapeutic effectiveness of percutaneous drainage and antibiotics was more beneficial than only antibiotics in treating patients with an appendiceal abscess. We also found three factors that were significantly associated with receiving an interval appendectomy: recurrent appendicitis, being aged ≤ 13 years, and treatment with antibiotics only.

• Appendiceal abscess
• Interval appendectomy
• Percutaneous drainage

Choledochal cyst (CC)—a congenital anomaly of the bile duct—is rare. We report a 28-year-old woman complaining of epigastralgia who was transferred to our hospital. Physical examination revealed severe tenderness to abdominal palpation without symptoms of diffuse peritonitis. Urgent contrast-enhanced abdominal computed tomography indicated the dilated common bile duct (CBD) was perforated, with a presumed diagnosis of perforated CC. Endoscopic external biliary drainage was performed immediately as a bridging procedure to the definitive surgery. Additional evaluations confirmed a type IVa CC, according to Todani’s classification, but no signs of malignancy. Twenty-two days after biliary drainage, laparotomy was performed. A large cystic mass was found in the CBD with a perforated scar on the right-side wall. Because inflammation around the pancreas head was too severe to perform cyst excision safely, the patient underwent subtotal stomach-preserving pancreatoduodenectomy. The postoperative course was uneventful, and the patient was discharged on the 29th postoperative day. Pathologic examination of a specimen showed no malignancy, and the patient has remained well during the 3-year follow-up. Our experience with this case suggests that definitive single-stage surgery for perforated CC in an adult can be performed safely owing to external biliary drainage as a bridging procedure, if manifestation of diffuse peritonitis is not evident.

• Adult
• Choledochal cyst
• Endoscopic biliary drainage
• Perforation
• Single-stage surgery

• Abscess
• Appendicitis
• Child
• Interval appendectomy

At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient’s own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn’s disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.

• Appendicitis
• Phlegmon
• Abscess
• Computed tomography
• Antibiotics
• Percutaneous drainage
• Surgery

• Abscess/diagnosis
• Abscess/therapy
• Adult
• Anti-Bacterial Agents/therapeutic use
• Appendectomy
• Appendicitis/diagnosis
• Appendicitis/therapy
• Appendix/drug effects
• Appendix/pathology
• Appendix/surgery
• Drainage
• Humans

Appropriate management of appendix mass is based on an accurate diagnosis of the underlying pathology. This is a report of a complex patient presenting with an appendix mass, whose surgery was deferred due to severe co-morbidities and who later died from severe metastatic disease. A 65-year-old lady presented with right iliac fossa pain and a mass. She was treated for an appendix mass initially and when the mass failed to resolve after four weeks, she was thoroughly investigated for the possibility of a tumour. Severe co-morbities had a significant impact on her management as definitive surgery was delayed. She represented 10 months after the initial admission with small bowel obstruction and died of metastatic caecal cancer. Management of appendix mass must entail a careful approach to investigating and treatment with emphasis on early intervention if the mass does not resolve promptly. This will avoid delayed diagnosis, treatment and a detrimental impact on prognosis.

• appendix mass
• caecal cancer
• computed tomography.

The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned. Furthermore, emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis. There is an increasing volume of evidence -although mostly retrospective- that if traditional conservative management is adopted, there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms. On the other hand, the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate. It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology. Moreover, it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration. If emergency LA is to become the standard of care for appendiceal mass, I.A will certainly become ‘something’ of the past.

• Appendiceal mass
• Cost-effectiveness
• Interval appendicectomy
• Laparoscopic appendicectomy

Management strategy in acute appendicitis patients initially presenting with abscess or mass is surrounded with controversy. This study was performed to identify the outcomes of management for this condition.

We retrospectively analyzed prospectively registered 76 patients (male:female = 39:37; mean age, 50.8 years) with appendicitis presenting with abscess or mass over a 9-year period at the Seoul National University Hospital. Patients were divided into three groups (emergency operation group, delayed operation group, and follow-up group), and clinical characteristics and outcomes of treatment were investigated.

Twenty-eight patients (36.8%) underwent an emergency operation. Of the remaining 48 patients, 20 (41.7%) were initially treated with conservative management through the use of antibiotics only; the other 28 (58.3%) with and additional ultrasound-guided percutaneous drainage of the abscess. Twenty-six (54.2%) patients underwent planned operations after conservative management, and 22 (45.8%) were followed without surgery (median duration, 37.8 month), of which 3 (13%) underwent an appendectomy due to recurrent appendicitis (mean of 56.7 days after initial attack). There were no statistical differences in types of operation performed (appendectomy or ileocecectomy), postoperative complications, and postoperative hospital stay among the patients who underwent emergency operations, delayed operations and operations for recurrence during follow-up.

Although the recurrence rate was relatively low after conservative management for appendicitis patients presenting with abscess or mass, there was no difference in surgical outcome between the emergent, elective, or recurrent groups. Our results indicate that proper management of appendicitis with abscess or mass can be selected according to surgeon's preference.

• Abscess
• Appendicitis
• Mass
• Treatment outcome

• Abdominal Abscess/complications
• Abdominal Abscess/surgery
• Anti-Bacterial Agents/therapeutic use
• Appendectomy/mortality
• Appendicitis/complications
• Appendicitis/mortality
• Appendicitis/surgery
• Appendicitis/therapy
• Cellulitis/complications
• Cellulitis/surgery
• Humans
• Intestinal Perforation/complications
• Intestinal Perforation/surgery
• Length of Stay
• Patient Selection
• Pneumonia/epidemiology
• Postoperative Complications/epidemiology
• Prospective Studies
• Retrospective Studies
• Surgical Wound Infection/epidemiology
• Treatment Outcome

• Adolescent
• Adult
• Aged
• Appendectomy
• Appendicitis/complications
• Appendicitis/diagnostic imaging
• Appendicitis/surgery
• Appendicitis/therapy
• Drainage/methods
• Female
• Humans
• Male
• Middle Aged
• Recurrence
• Ultrasonography

• Adolescent
• Appendicitis/diagnostic imaging
• Appendicitis/drug therapy
• Appendicitis/surgery
• Child
• Hospitals, Pediatric
• Humans
• Preoperative Care
• Retrospective Studies
• Tomography, X-Ray Computed

• KL2 RR024149 NCRR NIH HHS
• KL2 RR024149-05 NCRR NIH HHS

• Adolescent
• Appendectomy
• Appendicitis/surgery
• Appendicitis/therapy
• Child
• Female
• Humans
• Male
• Recurrence

• Adolescent
• Appendectomy/methods
• Appendix/pathology
• C-Reactive Protein/analysis
• Cecal Diseases/surgery
• Child
• Child, Preschool
• Drainage/methods
• Female
• Humans
• Length of Stay
• Male
• Penicillanic Acid/administration & dosage
• Penicillanic Acid/analogs & derivatives
• Tazobactam

• Abscess/epidemiology
• Anti-Bacterial Agents/administration & dosage
• Anti-Bacterial Agents/therapeutic use
• Appendectomy/statistics & numerical data
• Appendicitis/diagnostic imaging
• Appendicitis/drug therapy
• Appendicitis/epidemiology
• Appendicitis/surgery
• Calculi/epidemiology
• Cecal Diseases/epidemiology
• Child
• Child, Preschool
• Drug Administration Schedule
• Female
• Humans
• Intestinal Obstruction/epidemiology
• Laparoscopy/statistics & numerical data
• Length of Stay/statistics & numerical data
• Leukocyte Count
• Male
• Retrospective Studies
• Risk Factors
• Time Factors
• Tomography, X-Ray Computed/statistics & numerical data
• Treatment Failure

• Adolescent
• Appendectomy
• Appendicitis/surgery
• Appendicitis/therapy
• Case-Control Studies
• Child
• Child, Preschool
• Female
• Humans
• Male

• Abdominal Abscess/complications
• Adolescent
• Appendicitis/etiology
• Appendicitis/therapy
• Appendix
• Calculi/complications
• Cecal Diseases/complications
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Male
• Prognosis
• Recurrence

• Adolescent
• Appendectomy
• Appendicitis/diagnosis
• Appendicitis/surgery
• Child
• Child, Preschool
• Female
• Humans
• Male
• Retrospective Studies

• Abdominal Abscess/drug therapy
• Abdominal Abscess/etiology
• Abdominal Abscess/surgery
• Adolescent
• Anti-Bacterial Agents/therapeutic use
• Appendectomy/methods
• Appendicitis/complications
• Appendicitis/diagnostic imaging
• Appendicitis/drug therapy
• Appendicitis/surgery
• Cellulitis/drug therapy
• Cellulitis/etiology
• Cellulitis/surgery
• Child
• Drainage
• Female
• Humans
• Male
• Outcome Assessment, Health Care
• Penicillanic Acid/analogs & derivatives
• Penicillanic Acid/therapeutic use
• Piperacillin/therapeutic use
• Piperacillin, Tazobactam Drug Combination
• Predictive Value of Tests
• Prognosis
• Retrospective Studies
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome