PERFORATED APPENDICITIS IN CHILDREN - RISK-FACTORS FOR THE DEVELOPMENT OF COMPLICATIONS

Background. Many aspects of the management of perforated appendicitis In children remain controversial. The objective of this study was to d efine risk factors associated with the development of postoperative co mplications in children undergoing treatment for perforated appendicit is. Methods. We reviewed all children (age < 16 years) who were treate d for perforated appendicitis at Cardinal Glennon Children's Hospital between 1988 and 1997. Inclusion criteria included either gross or mic roscopic evidence of appendiceal perforation. Results. Of 285 children with perforated appendicitis, 279 underwent immediate operative treat ment. Mean patient age was 7.7 years and there were no deaths. Major p ostoperative complications included intra-abdominal abscess (n = 17), ileus (n = 7), mechanical intestinal obstruction (n = 6) and wound inf ection (n = 4). All children who had a postoperative abscess had more than 5 days of symptoms before operation. Within this subgroup, drain placement was associated with not only decreased postoperative abscess formation and but also shorter duration of fever and length of hospit alization. The incidence of mechanical obstruction or ileus was not in creased and the rate of wound infection was actually lower after drain age. Conclusions. Drain placement appears to be helpful in children wi th late diagnosis but is of little benefit when the duration of sympto ms is less than 5 days. Thus it is likely that drains are most useful in patients With well-established and localized abscess cavities.