Presentation Complicated appendicitis in children: a clear role for drainage and delayed appendectomy Jonathan P. Roach, M.D. a , David A. Partrick, M.D. b, *, Jennifer L. Bruny, M.D. b , Michael J. Allshouse, D.O. b , Frederick M. Karrer, M.D. b , Moritz M. Ziegler, M.D. b a Department of Surgery, The University of Colorado Health Sciences Center, 4200 E. 9th Ave, Denver, CO 80262, USA b Department of Pediatric Surgery, The Children’s Hospital, 1056 E. 19th Ave, B-323, Denver, CO 80218, USA Manuscript received June 2, 2007; revised manuscript August 13, 2007 Presented at the 59th Annual Meeting of the Southwestern Surgical Congress, Rancho Mirage, CA, March 25–29, 2007 Abstract Introduction: Children presenting with complicated appendicitis represent a common and challenging problem. Conflicting data exist concerning optimal treatment of these patients with primary versus delayed appendectomy. Methods: A retrospective review of all children undergoing appendectomy over a 5-year period was performed. Results: We identified 1,106 children: 360 had evidence of perforation and 92 had an intra-abdominal abscess or right lower quadrant phlegmon. Of these 92, 60 underwent primary appendectomy and 32 underwent drainage and/or antibiotic therapy with delayed appendectomy. Children undergoing delayed appendectomy had a longer prodrome of symptoms (6.9 vs 4.6 days, P = .002), slightly higher presenting white blood cell count (19.3 vs 16.6, P = .08), and had the same hospital length of stay, yet had a lower complication rate requiring readmission to the hospital (0% vs 10%) compared to those undergoing immediate appendectomy. Conclusion: In children presenting with prolonged symptoms and a discrete appendiceal abscess or phlegmon, drainage and delayed appendectomy should be the treatment of choice. © 2007 Excerpta Medica Inc. All rights reserved. Keywords: Complicated appendicitis; Delayed appendectomy; Pediatric; Perforated appendicitis; Laparoscopy Appendicitis is a common surgical disease that can present across a broad spectrum of symptoms and pathologies. There are approximately 250,000 cases of appendicitis per year in the United States and an individual’s lifetime risk for appendicitis is approximately 8% [1]. While adults are often able to give an accurate history of the prodrome of symp- toms experienced, children are less likely to be reliable historians given their age. This is one reason that many younger children present with more advanced appendicitis involving perforation and possible abscess formation [2– 4]. While much has been written in the literature about appen- dicitis and the management of acute appendicitis is well described [5], controversy remains as to the optimal treat- ment of complicated appendicitis [6–8]. We have previ- ously reported that laparoscopic appendectomy is an excel- lent and useful approach in children with appendicitis, but the delayed operative management of complicated appen- dicitis was not specifically addressed [2]. The purpose of the current study was to determine the optimal treatment of complicated appendicitis in children. Our hypothesis was that primary drainage accompanied by antibiotic therapy has a clear role in the treatment of complicated appendicitis and we sought to define a patient population where this treatment protocol is efficacious. Methods All children undergoing open or laparoscopic appendec- tomy from January 2000 through August 2006 were iden- tified by the operating room records from The Children’s Hospital in Denver. Children undergoing appendectomy for reasons other than appendicitis were excluded from the study population (ie, children undergoing incidental appen- * Corresponding author. Tel.: +1-720-777-6571; fax: +1-720-777-7172. E-mail address: Partrick.David@tchden.org The American Journal of Surgery 194 (2007) 769 –773 0002-9610/07/$ – see front matter © 2007 Excerpta Medica Inc. All rights reserved. doi:10.1016/j.amjsurg.2007.08.021