Non-operative Management of Pediatric Appendicitis With an Appendicoltih

Not Applicable

Terminated

Brief Summary: To determine if non-operative management with antibiotics alone is a feasible treatment alternative for pediatric patients with uncomplicated acute appendicitis with an appendicolith identified on imaging.

Detailed Description: This study is a prospective randomized clinical trial comparing non-operative management with antibiotics to urgent appendectomy in children (ages 7-17yrs) with acute appendicitis with the presence of an appendicolith. Enrolled participants were followed up to 1 year post-discharge to observe the rates of appendicitis recurrence as well as identify the number of patients with complicated appendicitis as determined by pathologic examination.

Recruitment & Eligibility

Inclusion Criteria

Age : 7-17 years
Abdominal pain </= 48hours prior to receiving antibiotics
White Blood Cell Count >5 but < 18
US or CT confirmed early appendicitis plus:
- US: </=1.1 cm in diameter, presence of appendicolith
- CT: </= 1.1cm in diameter, presence of appendicolith

Exclusion Criteria

Positive urine pregnancy test
Pain > 48 hours prior to first antibiotic dose
Diffuse peritonitis
History of chronic intermittent abdominal pain
White Blood Cell count ≤ 5 or ≥ 18
Absence of appendicolith or any evidence on imaging studies concerning for evolving perforated appendicitis including abscess or phlegmon

Arm && Interventions

Group	Intervention	Description
Non-operative Management	Antibiotics only (Zosyn then Augmentin)	Non-operative management with antibiotics only Zosyn (Piperacillin/Tazobactam) and then Augmentin unless penicillin allergic Cipro/Flagyl if penicillin allergic

Primary Outcome Measures

Name	Time	Method
Number of Participants That Did Not Have an Appendectomy	1 year	Percentage of patients who were successfully managed nonoperatively with success defined as not undergoing appendectomy by one year after discharge

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Complicated Appendicitis	1 year	Percent of patients found to have complicated appendicitis (gangrenous or perforated) on pathologic examination.