Abstract
Aim To define patterns in the management of pediatric appendicitis.
Methods A total of 169 delegates from 42 (24 European) countries completed a validated survey
administered at the EUPSA 2017 annual congress.
Results In the work-up of children with suspected acute appendicitis, most surgeons rely
on full blood count (92%), C-reactive protein (82%), and abdominal ultrasonography
(76%), but rarely on computed tomography scans or magnetic resonance imaging. In suspected
simple appendicitis, most surgeons (76%) do not perform appendectomy at night in clinically
stable patients and start antibiotic preoperatively (64%), but only 15% offer antibiotic
therapy alone (no appendectomy). In suspected perforated appendicitis, 96% start antibiotic
preoperatively, and 92% perform an appendectomy. Presence of phlegmon/abscess is the
main contraindication to immediate surgery. In case of appendix mass, most responders
(75%) favor a conservative approach and perform interval appendectomy always (56%)
or in selected cases (38%) between 2 and 6 months from the first episode (81%). Children
with large intraperitoneal abscesses are managed by percutaneous drainage (59% responders)
and by surgery (37% responders). Laparoscopy is the preferred surgical approach for
both simple (89%) and perforated appendicitis (81%). Most surgeons send the appendix
for histology (96%) and pus for microbiology, if present (78%). At the end of the
operation, 58% irrigate the abdominal cavity only if contaminated using saline solution
(93%). In selected cases, 52% leave a drain in situ.
Conclusion Some aspects of appendicitis management lack consensus, particularly appendix mass
and intraperitoneal abscess. Evidence-based guidelines should be developed, which
may help standardize care and improve clinical outcomes.
Keywords
appendectomy - perforated - antibiotics - children - pediatric
