Management of Perforated Appendicitis in Children The Controversy Continues

Abstract

A specific treatment plan for management of perforated appendix in children, initiated at the Children''s Hospital in Boston, Massachusetts, USA, and later utilized at the Child Health Center in Galveston, Texas, USA, was applied to 143 patients by many surgical housestaff and faculty. The protocol consists of appendectomy, routine use of systemic gentamicin, ampicillin and clindamycin, antibiotic peritoneal irrigation and transperitoneal drainage through the incision. The average age of the children in this series was 9.1 yr (range 14 mo.-21 yr). The average length of hospitalization was 12.1 days. The use of this protocol resulted in only 11 patients (7.7%) developing significant complications. Complications related to infection occurred in only 6 of the 11 patients (4.2%). There were no deaths. This protocol of intensive primary therapy can significantly decrease the sequelae from perforated appendicitis in children.