Ramon R Gorter1, Paul van Amstel2, Johanna H van der Lee3, Patick van der Voorn4, Roel Bakx5, Hugo A Heij6. 1. Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, P.O. Box 22660, 1100DD Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Vondellaan 13 1942 LE, Beverwijk, The Netherlands. Electronic address: rr.gorter@vumc.nl. 2. Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, P.O. Box 22660, 1100DD Amsterdam, The Netherlands. Electronic address: p.van.amstel@student.vu.nl. 3. Paediatric Clinical Research Office, Division Woman and Child, Academic Medical Centre, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. Electronic address: j.h.vanderlee@amc.uva.nl. 4. Department of Pathology, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands. Electronic address: jp.vanderVoorn@vumc.nl. 5. Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, P.O. Box 22660, 1100DD Amsterdam, The Netherlands. Electronic address: r.bakx@amc.uva.nl. 6. Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, P.O. Box 22660, 1100DD Amsterdam, The Netherlands. Electronic address: hugo.heij@icloud.com.
Abstract
BACKGROUND: To determine if non-operative treatment is safe in children with acute appendicitis, we evaluated the incidence of unexpected findings after an appendectomy in children, and the influence they have on subsequent treatment. METHODS: A historical cohort study (January 2004-December 2014) was performed including children, aged 0-17 years, who underwent an appendectomy for the suspicion of acute appendicitis. Patients were divided based upon histopathological examination. Unexpected findings were reviewed, as well as the subsequent treatment plan. RESULTS: In total 484 patients were included in this study. In the overall group, unexpected findings were noted in 10 (2.1%) patients of which two patients intra-operatively with a non-inflamed appendix (Ileitis terminalis N=1 and ovarian torsion N=1) and in 8 patients on histopathological examination. The latter group consisted of 4 patients with concomitant simple appendicitis (parasitic infection N=3 and Walthard cell rest N=1), two with concomitant complex appendicitis (carcinoid N=1 and parasitic infection N=1) and two patients with a non-inflamed appendix (endometriosis N=1 and parasitic infection N=1). Treatment was changed in 4 patients (<1%). CONCLUSIONS: Results from this study corroborate the safety of non-operative strategy for acute simple appendicitis, as the occurrence of unexpected findings was low, with extremely few necessary changes of the treatment plan because of serious findings. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level 2 (retrospective cohort study).
BACKGROUND: To determine if non-operative treatment is safe in children with acute appendicitis, we evaluated the incidence of unexpected findings after an appendectomy in children, and the influence they have on subsequent treatment. METHODS: A historical cohort study (January 2004-December 2014) was performed including children, aged 0-17 years, who underwent an appendectomy for the suspicion of acute appendicitis. Patients were divided based upon histopathological examination. Unexpected findings were reviewed, as well as the subsequent treatment plan. RESULTS: In total 484 patients were included in this study. In the overall group, unexpected findings were noted in 10 (2.1%) patients of which two patients intra-operatively with a non-inflamed appendix (Ileitis terminalis N=1 and ovarian torsion N=1) and in 8 patients on histopathological examination. The latter group consisted of 4 patients with concomitant simple appendicitis (parasitic infection N=3 and Walthard cell rest N=1), two with concomitant complex appendicitis (carcinoid N=1 and parasitic infection N=1) and two patients with a non-inflamed appendix (endometriosis N=1 and parasitic infection N=1). Treatment was changed in 4 patients (<1%). CONCLUSIONS: Results from this study corroborate the safety of non-operative strategy for acute simple appendicitis, as the occurrence of unexpected findings was low, with extremely few necessary changes of the treatment plan because of serious findings. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level 2 (retrospective cohort study).
Authors: Max Knaapen; Johanna H van der Lee; Roel Bakx; Sarah-May L The; Ernst W E van Heurn; Hugo A Heij; Ramon R Gorter Journal: BMJ Open Date: 2017-11-15 Impact factor: 2.692
Authors: Paul van Amstel; Roel Bakx; Johanna H van der Lee; Marijke C van der Weide; Rik van Eekelen; Joep P M Derikx; Ernest L W van Heurn; Ramon R Gorter Journal: BMJ Open Date: 2022-02-17 Impact factor: 2.692