Published online Apr 27, 2020. doi: 10.4240/wjgs.v12.i4.129
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
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.
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.