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Appendicitis, Suspected

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Algorithm for Suspected Appendicits

Appendicitis

Gentamicin*

Given as a once daily dose - refer to current Paediatric Aminoglycoside and Vancomycin Guidelines for further information on dosing and required monitoring of peak and trough levels (ADHB pharmacy intranet site  including Paediatric Pharmacopoeia).

Notes

Laparoscopic versus open appendicectomy

The literature is still controversial, and most recent studies do not show significant differences between the two for length of stay, pain relief, complications and return to normal activity. The decision to be made by surgeon and patient depending on consultant, timing of operation and skill level of surgeon. Laparoscopy would be preferable for female patients with diagnostic uncertainty and for children who would have better access laparoscopically (i.e. obese). Internal audit (Nov 03 - Jun 04 suggests better outcome with laparoscopy in terms of length of stay and complications).

Overnight delay

Studies show no significant morbidity or complications from waiting overnight for appendicectomy.

Appendiceal Mass

Again controversial, but most papers advocate conservative management with broad spectrum antibiotics and interval appendicectomy. Incidence of ~16-40% will fail conservative management and require drainage or operation earlier than the booked interval appendicectomy. It is unknown which patients will be likely to be in this group, therefore interval appendicectomy is still recommended.

References

Emil S, Laberge JM, Mikhail P, et al: Appendicitis in children: a ten-year update of therapeutic recommendations. J Pediatr Surg. 2003 Feb; 38(2): 236-42 

Andersen BR, Kallehave FL, Andersen HK: Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. 

Meguerditchian A, Prasil P, Cloutier R et al: Laparoscopic appendectomy in children: A favourable alternative in simple and complicate appendicitis. J Pediatr Surg. 2002 May; 37(5): 695-698. 

Little DC, Custer MD, May BH et al: Laparoscopic appendectomy: an unnecessary and expensive procedure in children? J Pediatr Surg. 2002 March; 37(3): 310-317. 

Lau WY, Fan ST, Chu KW et al: Cefoxitin versus gentamicin and metronidazole in prevention of post-appendicectomy sepsis: a randomized, prospective trial. Journal of antimicrobial chemotherapy. 1986 Nov;18(5): 613-9. 

Samuel M, Hosie G, Holmes K: Prospective evaluation of nonsurgical versus surgical management of appeniceal mass. J Pediatr Surg 2002 Jun; 37(6): 882-886.

Gahukamble DB, Gahukamble LD: Surgical and pathological basis for interval appendicectomy after resolution of appendicular mass in children. J Pediatr Surg 2000 Mar; 35(3): 424-427 

Gillick J, Velayudham M, Puri P: Conservative management of appendix mass in children. Br J Surg 2001, 88: 1539-1542. 

Elridge B, Kimber C, Wolfe R et al: Uptime as a measure of recovery in children postappendectomy. J Pediatr Surg 2003 Dec; 38(12): 1822-1825. 

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Document Control

  • Date last published: 01 October 2005
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Surgery
  • Author(s): James Hamill, Bhavesh Patel
  • Editor: Greg Williams
  • Review frequency: 2 years

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