Introduction:
Acute appendicitis is the most emergency in children. Appendectomy is the removal of the appendix surgically. Non-surgical treatment of acute appendicitis in children is an alternative to appendectomy. The nonoperative treatment of acute appendicitis in children is safe and effective.
What Is Appendicitis?
Appendicitis is a condition in which there is an inflammation of the appendix, a finger-shaped small organ that projects from the colon on the lower right side of the abdomen. The appendix is a reservoir of organisms like bacteria that build up the gut flora and is required to recolonize the gut after a bout of bacterial infection such as diarrhea. Appendicitis might cause pain in the lower right side of the abdomen. The appendicitis pain usually begins around the navel area and then moves upwards. The appendicitis pain increases with inflammation and eventually becomes severe. Anyone can develop appendicitis, but most commonly, it occurs in individuals between 10 and 30 years old. The standard treatment of appendicitis is the surgical removal of the appendix.
Appendicitis is progressive in nature as the disease transforms from being uncomplicated inflammation at the beginning of symptoms to perforation within 48 hours. The clinical features of appendicitis in kids vary from being minimally symptomatic with pain in the lower right abdomen to septic shock complicated by perforation, pus formation inside the abdomen, and spreading of infection. In kids under five years of age, the signs and symptoms of appendicitis may differ from the usual. Perforation is most commonly seen in younger kids who cannot communicate symptoms properly.
What Are the Symptoms of Appendicitis?
The sign of symptoms of appendicitis includes the following:
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Sudden pain on the right side of the lower abdomen.
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Pain worsens with coughing, walking, or other movements.
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Low-grade fever that worsens with the illness.
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Nausea and vomiting.
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Bloating.
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Loss of appetite.
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Constipation or diarrhea
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Flatulence.
How Has the Treatment of Appendicitis Evolved?
The evolution of appendicitis diagnosis has progressed rapidly in the last few decades with development of scoring systems (Alvarado, Pediatric Appendicitis Score) and review of nonoperative article management of appendicitis in children Helene Nepomuceno, Erik G.
Appendicitis is a typical childhood and adolescent condition that requires urgent surgical intervention. For almost two decades, appendicitis has been considered a medical problem with a surgical solution. The appendix can be removed with a laparoscopically or minimally invasive approach, with common anesthetic and surgical risk and prompt hospital discharge. In spite of these advantages, the surgical procedure and anesthesia have risks, such as postoperative infection, bleeding, hernia, and other organ injury. Additionally, surgery requires absence from school and work to recover.
Studies conducted for adult individuals have demonstrated safety and efficiency in the nonoperative management of acute appendicitis. For children with uncomplicated appendicitis, initial nonoperative management of appendicitis has been found to be safe with fewer complications, fewer days of recovery, and reduced healthcare costs compared to surgery. In complicated appendicitis with an abscess or a tumor of the appendix, an initial nonoperative strategy with or without abscess drainage followed by appendectomy is the current mode of intervention. Resuscitation, antibiotics, and surgery have been the intervention method over the last century. The current intervention is a simple, minimally invasive surgery with few complications and a short hospital stay. However, this approach has been challenged with the nonoperative management of selected individuals with acute uncomplicated appendicitis. In children with complicated appendicitis, with intraabdominal abscess or tumor, initial nonoperative treatment with intravenous antibiotics and abscess drainage followed by interval appendectomy is the treatment of choice.
How Is Appendicitis Managed Non-operatively in Kids?
Appendectomy or surgical removal of the appendix is a simple solution to the problem of appendicitis involving low risk, a short hospital stay, and quick recovery. However, it still includes infection at the surgical site, hernias, bleeding, organ injury, pain, and side effects of general anesthesia. The nonoperative management of uncomplicated appendicitis, without abscess or tumor, has been associated with fewer complications, improved pain control, and fewer sick leaves. These benefits came along with higher recurrence rates with antibiotic management compared to appendectomy. Several studies have found that nonoperative treatment had only a 14 percent recurrence rate, and the majority of such individuals were successfully treated with a subsequent antibiotics regime and surgical avoidance. In kids, the rate of cancer growth is slow, approximately 0.3 percent, and the majority of these are appendix tumors. Nonoperative management of appendicitis in kids is popular among pediatric surgeons as it avoids the risks of general anesthesia and abdominal surgery. Non-opertively, appendocitis is managed with intravenous administration of antibiotics.
Acute appendicitis is a very common emergency in children, from uncomplicated to perforated, with complications including abscesses and tumors. Appendicitis has traditionally been managed surgically (appendectomy) with a minimally invasive technique (laparoscopically) with low surgical and anesthetic risk. Non-surgical management of acute appendicitis has been found to show both safety and effectiveness across various studies, with cost savings and reduced disability without increasing fatality. Correct patient selection for nonoperative treatment is essential as the nonoperative treatment can be carried out only in individuals with symptoms lasting for a limited time and confirmation from the imaging techniques of uncomplicated appendicitis. Patient and family education, as well as parent inclusion in the decision regarding the treatment procedure, is important when choosing a management strategy. Many studies are being conducted on the effectiveness of antibiotics over surgery. The current data from the studies show that the trial of nonoperative management is safe and efficient and does not increase the risk of complicated appendicitis, and is associated with lesser surgical complications, fewer recovery days, and lower healthcare costs.
Conclusion:
Nonsurgical treatment of acute appendicitis in children is relatively safe, with a minimal complication rate as compared to children undergoing an appendectomy. The treatment is successful, with the resolution of symptoms and early discharge from the hospital. After discharge, a few kids might undergo appendectomy due to recurrent acute appendicitis or recurrent abdominal pain with a normal appendix. The nonoperative management of uncomplicated and complicated appendicitis in children is well-tolerated in select populations
