Non-operative Management of Pediatric Appendicitis With an Appendicoltih
Non-operative Management of Pediatric Appendicitis With an Appendicoltih
To determine if non-operative management with antibiotics alone is a feasible treatment
 alternative for pediatric patients with uncomplicated acute appendicitis with an
 appendicolith identified on imaging.
This study is a prospective randomized clinical trial comparing non-operative management with
 antibiotics to urgent appendectomy in children (ages 7-17yrs) with acute appendicitis with
 the presence of an appendicolith. Enrolled participants were followed up to 1 year
 post-discharge to observe the rates of appendicitis recurrence as well as identify the number
 of patients with complicated appendicitis as determined by pathologic examination.
Inclusion Criteria:

 -  Age : 7-17 years

 -  Abdominal pain </= 48hours prior to receiving antibiotics

 -  White Blood Cell Count >5 but < 18

 -  US or CT confirmed early appendicitis plus:

 -  US: </=1.1 cm in diameter, presence of appendicolith

 -  CT: </= 1.1cm in diameter, presence of appendicolith

 Exclusion Criteria:

 -  Positive urine pregnancy test

 -  Pain > 48 hours prior to first antibiotic dose

 -  Diffuse peritonitis

 -  History of chronic intermittent abdominal pain

 -  White Blood Cell count ≤ 5 or ≥ 18

 -  Absence of appendicolith or any evidence on imaging studies concerning for evolving
 perforated appendicitis including abscess or phlegmon