INTERVAL APPENDECTOMY FOR PERFORATED APPENDICITIS IN CHILDREN

To determine the efficacy, safety, and cost of managing perforated app endicitis with intravenous antibiotics followed by an interval appende ctomy, the charts of 87 children with ruptured appendicitis were retro spectively reviewed. These patients were treated with intravenous flui d resuscitation and antibiotics (consisting of clindamycin and ceftazi dime) and underwent appendectomy, either on that admission (n 46) or a s a delayed interval procedure (n 41). Antibiotics in all cases were d iscontinued either at home or in the hospital after the child was a fe brile for 48 hours with normal white and differential blood cell count s, and the two groups were compared. Seven patients (17%) ''failed'' t he interval appendectomy protocol. All but one ''failure'' was due to the development or persistence for >72 hours of a bowel obstruction. T he data are described below as percent or mean +/- 1 standard deviatio n. [GRAPHICS] We conclude that antibiotics and interval appendectomy i s a safe effective alternative for the management of perforated append icitis. When successful, hospitalization, charges, and morbidity are l ess with this approach. A persistent bowel obstruction for 72 hours is an indication to proceed with appendectomy on admission.