Appendicitis in children.

A study of 406 consecutive children operated upon for appendicitis from July 1982 to July 1987 was compared with a previously published study of 657 children with the same diagnosis operated upon between 1972 and 1982. This was done to determine if the methods of therapy continue to yield low complication rates and zero mortality rates. The routine use of antibiotic coverage for both aerobic and anaerobic bacteria in perforated appendicitis resulted in low complication rates, 3.2 per cent for major and 2.5 per cent for minor complications. Major complications included small intestinal obstruction and intra-abdominal abscess. Minor complications included wound infection and prolonged ileus. These rates are similar to those of the first investigation. The mortality rate continued to be zero. Complete peritoneal lavage was used in patients with generalized peritonitis or extensive localized peritonitis. Operative lysis of adhesions for small intestinal obstruction was required in four of these patients. This did not occur in patients with perforated appendicitis with abscess formation or more localized peritonitis who had no lavage. The technique rather than the disease process may be responsible for the complication.