Non-operative management of early, acute appendicitis in children: is it safe and effective?

J Pediatr Surg. 2014 May;49(5):782-5. doi: 10.1016/j.jpedsurg.2014.02.071. Epub 2014 Feb 22.


Purpose: The purpose of this study was to determine if early, acute appendicitis in children can be safely and effectively managed with antibiotics alone.

Methods: A retrospective review was performed of children (<18 yrs) treated non-operatively (NOM) for early, acute appendicitis since May 2012. These were compared to patients treated with appendectomy between January 2011 and October 2011 (OM). Inclusion criteria included: (a) symptoms <48 h, (b) localized peritonitis, and (c) ultrasound findings consistent with early, acute appendicitis.

Results: Twelve patients (66% female, mean age 12.2,SD=4.2 yrs) were treated non-operatively, while 12 (50% female, mean age 12.5,SD=3.2 yrs) were treated operatively. Two NOM children (16.7%) required initial appendectomy. One patient developed recurrent appendicitis requiring appendectomy 7 months post-discharge. Four other NOM patients returned with symptoms but did not require admission or surgery. Two OM patients (8.3%) had hospital visits and admissions related to surgical site infections. Mean length of stay (LOS) for the first visit was 1.5 days (SD=1.0d) (NOM) vs. 1.3 days (SD=0.5d) (OM) (p=0.61). Including first and subsequent admissions, mean LOS was 1.8 days (SD=1.1d) (NOM) vs. 1.7 days (SD=1.5d) (OM) (p=0.97).

Conclusion: Early acute appendicitis in appropriately selected children can be successfully treated non-operatively. Randomized trials with longer follow-up are required.

Keywords: Antibiotics; Appendicitis; Non-operative management.

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use*
  • Appendectomy
  • Appendicitis / diagnosis*
  • Appendicitis / drug therapy*
  • Appendicitis / surgery
  • Child
  • Early Diagnosis
  • Female
  • Humans
  • Length of Stay
  • Male
  • Patient Readmission
  • Recurrence
  • Retrospective Studies
  • Surgical Wound Infection / drug therapy
  • Treatment Outcome


  • Anti-Bacterial Agents