Perforated Appendicitis With Delayed Presentation
Perforated Appendicitis With Delayed Presentation
There is no consensus among pediatric surgeons regarding the optimal treatment for children
 with complicated appendicitis with delayed diagnosis. With the development of broad-spectrum
 antibiotics, some surgeons have advocated expectant management for these children. However,
 there is little evidence to determine which children are most likely to benefit from this
 approach. Prior attempts to determine the effectiveness of expectant management for
 perforated appendicitis with delayed diagnosis often have not controlled for inherent
 differences in the clinical status of patients treated non-operatively vs. those treated with
 immediate appendectomy.
The ability of clinical practice guidelines to improve clinical practice and optimize
 resource utilization continues to be substantiated in the literature. To be effective,
 clinical practice guidelines must be developed from reliable and reproducible data.

 This trial prospectively compares expectant management versus immediate laparoscopic or open
 appendectomy for perforated appendicitis in children with a delayed diagnosis. The primary
 outcome measure is length of hospital stay.
Inclusion Criteria:

 -  All children with a delayed diagnosis of perforated appendicitis. Delayed diagnosis
 will be defined as symptoms for 4 or more days. Duration of symptoms will be defined
 as the time pain started.

 -  Confirmed diagnosis of perforated appendicitis. The diagnosis of perforated
 appendicitis will be based on diagnostic imaging (CT scan or ultrasound), showing an
 established appendiceal abscess or phlegmon.

 -  Consent to participate

 Exclusion Criteria:

 -  Uncertainty about the diagnosis.

 -  The need for laparotomy for another reason.

 -  Free intraperitoneal air on imaging.

 -  Perforated appendicitis with diffuse abdominal fluid on imaging associated with a
 clinical picture of severe sepsis.

 -  Children with other medical condition that may affect the decision to operate e.g:
 children with inflammatory bowel disease.