Acute perforated appendicitis in childhood; analysis of management, including the use of hypothermia.

From an analysis of a recent series of 99 cases of acute perforated appendicitis in childhood several conclusions appeared valid.1. The majority of infants and young children with acute perforated appendicitis do not exhibit the signs of localization of peritoneal irritation so characteristically seen in older children and adults. Hence if a history compatible with acute perforated appendicitis is present and there is evidence of peritoneal irritation on repeated examinations, patients of this age group may be assumed to have the disease and should be prepared and operated upon with minimal delay. Early operation after a maximum of several hours of preparation with parenteral hydration, nasogastric suction and antibiotics is the treatment of choice.2. In nine patients in the present series with temperature and rapid pulse that did not fall to safe levels with the usual preoperative preparation, mild hypothermia appeared to reduce the risk of anesthesia and operation.3. The use of intraperitoneal drains in children with acute perforated appendicitis is associated with a definite reduction in the incidence of postoperative intraperitoneal abscesses and with a probable reduction in the number of serious wound infections.