Younas Khan, Muhammad Ayub Khan, Kifayat Khan.
Management of Complicated Appendicitis in Children.
Ophthalmol Update Jan ;15(2):167-70.

Objective: To evaluate the results of aggressive approach in the treatment of complicated appendicitis in children. Material and Methods: This study was conducted on Paediatric patients with complicated appendicitis at the department of Paediatric Surgery, Medical Teaching Institute, Lady Reading Hospital Peshawar from January 2016 to December 2016. After clinical examination, relevant investigations and primary assessment those children with proven diagnosis of complicated appendicitis were included in this trial. After admission and primary resuscitating, patients kept NPO at least for 6 hours, antibiotic therapy was initiated and laparotomy through right transverse incision was performed under general anesthesia. In this approach there is no need for further treatment, waste of time, performing final treatment in one stage. Control of infection and not to let the puss to spread in peritoneal cavity is the prime requirement. Results: Among 70 children with acute complicated appendicitis, male to female ratio was 4:1 and age range was from 3 years to 13 years. Through upper right transverse incision 42 cases were operated and 28 cases by lower right small transverse incision. The most common final diagnosis was appendicular abscess, observed in 40 patients. Primary wound closure was performed in all 70 patients and placement of drain in peritoneal cavity in right lower quadrant was done only in 14 cases. Safe appendectomy was performed in all 70 cases and post operative complications included 6 cases with wound infection and 4 cases with chronic abdominal pain that were managed conservatively. Only one patient was re-admitted and underwent re-laparotomy because of bowel obstruction. Conclusion : According to our findings the current non-operative approach to complicated appendicitis in children needs a revision.

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