Is Non-Surgical Appendicitis Treatment an Option for Your Child?

Non-Surgical Appendicitis Treatment Give Parents Options

Typically, when most parents hear the word appendicitis, they also hear the word surgery. Appendectomies have been performed safely for decades, and are a proven treatment for appendicitis. But what if there was a second treatment option that didn’t require surgery? If your child qualified, what if their appendicitis could be treated with antibiotics alone?

In our recent study, we found that three out of four children with uncomplicated appendicitis have been successfully treated by antibiotics alone after one year.

 

It is important to state that if your child develops right lower-quadrant pain, you should see a doctor. Call your pediatrician, or come into the hospital where an imaging study will be able to tell you whether or not your child has early appendicitis and if he/she might be a candidate for antibiotics only. The major benefit of surgery is that your child will never have appendicitis again.

The benefits of antibiotic treatment include:

  • Fewer days of missed school or work for patients and families
  • Less pain
  • Quicker recovery for your child

In our study:

  • 37 patient families chose antibiotics alone
  • 65 patient families chose surgery
  • Patients in the non-operative group were admitted to the hospital and received IV antibiotics for at least 24 hours, followed by oral antibiotics for a total of 10 days after discharge
  • Among those patients, 94 percent showed improvement within 24 hours and only 2 patients were readmitted within 30 days for an appendectomy

In order to be a candidate for the study, patients needed to:

  • Have uncomplicated appendicitis, meaning abdominal pain for only 48 hours
  • Have a white cell count less than 18
  • Undergo an ultrasound or CT scan to rule out rupture and to verify that their appendix was 1.1 centimeter thick or smaller.
  • Have no evidence of an abscess or fecalith (a hard, stone-like piece of stool)

The most important facet of this study is the ability of patients and their families to choose their treatment. If these requirements are met, the family ultimately gets to decide what they prefer based on what is important to them. There is no right or wrong decision when it comes to treatment. Both options have pros and cons. For example, a family who wants to avoid the risk of appendicitis coming back again may be more likely to choose surgery, while a family who is averse to surgery or who has cultural beliefs that align with avoiding surgery, may choose antibiotics. Involving families in the decision making process allows them to become part of the child’s care team and ensures that everything before, during, and after treatment is something the patient and the family are comfortable with.

As with any decision about your child’s health, it is important to present any questions or concerns to your child’s pediatrician to ensure that you understand and are comfortable with the choice you make.

Katherine Deans, MD
Dr. Deans graduated from Dartmouth Medical School and completed a surgery residency and research fellowship at Massachusetts General Hospital and the National Institutes of Health. She is board certified by the American Board of Surgery in Surgery, Surgical Critical Care, and Pediatric Surgery. She is a member of the American College of Surgeons, Society of Critical Care Medicine, and the American Pediatric Surgical Association.
Peter Minneci, MD
Dr. Minneci graduated from New York University School of Medicine and completed a surgery residency and research fellowship at Massachusetts General Hospital and the National Institutes of Health. He is board certified by the American Board of Surgery in Surgery and Surgical Critical Care and is a member of the American College of Surgeons, Society of Critical Care Medicine, and Alpha Omega Alpha.

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