Çocuklarda akut apandisitin ameliyatsız tedavisi

Abstract

Amaç: Akut apandisit için ameliyatsız tedaviyi ele alan çoğu çalışma yetişkinlere odaklanmıştır ve çocuklar için sınırlı veri mevcuttur. Akut komplikasyonsuz apandisitli çocuklarda başarılı ameliyatsız yönetimin sonuçlarını “ek kriterlerimiz” ile değerlendirmeyi ve hangi faktörlerin başarı oranını etkileyebileceğini ve hangi vakaların ameliyatsız tedaviye aday olabileceğini bulmayı amaçladık. Gereç ve yöntem: Akut komplikasyonsuz apandisit tanısı alan ve ameliyatsız tedavi uygulanan toplam 26 hasta retrospektif olarak yeniden değerlendirildi. Komplike olmayan apandisit tanımlaması semptomların süresine (<24 saat), klinik öyküye ve radyolojik bulgulara dayanıyordu. Radyolojik değerlendirme ultrasonografi ve bilgisayarlı tomografi ile yapıldı. Hastalara hastanede beş gün intravenöz antibiyotik kombinasyonu (sulbaktam/ampisilin, gentamisin, klindamisin) verildi; tedavi oral antibiyotik kombinasyonu (amoksisilin/klavulanat, metronidazol) ile 10 güne tamamlandı. Olguların ortalama takip süresi iki yıldı. Bulgular: Ortalama hasta yaşı ve takip süresi sırasıyla 10,42±3,65 yıl ve 30,15±5 aydı. Başvuru anındaki ortalama lökosit sayısı, C-reaktif protein (CRP) ve apendiks çapı değerleri 15,82±5,4×109/L, 20,38±33,4mg/dL ve 7,87±1,4 mm idi. Hastaların hiçbirinde erken başarısızlık, komplikasyon veya yan etki görülmedi. İzlemde sadece bir olguda (%4) tekrarlayan apandisit gelişti ve laparoskopik apendektomi ile tedavi edildi. Sonuç: Çocuklarda akut komplike olmayan apandisitin ameliyatsız yönetimi, kriterlerimize göre uzun vadeli sonuçlara göre tatmin ediciydi ve başlangıç başarı oranları mükemmeldi.

Keywords

• Akut apandisit
• apandisit
• çocuk
• konservatif tedavi
• ameliyatsız tedavi

Non-Operative management of acute appendicitis in children

Abstract

Purpose: Most studies addressing non-operative management for acute appendicitis have focused on adults, and there are limited data available for children. We aimed to evaluate the results of successful non-operative management in children with acute uncomplicated appendicitis with our “additional criteria” and find which factors could be affecting the success rate and which cases could be candidates for non-operative management. Materials and methods: A total of 26 patients who were diagnosed with acute uncomplicated appendicitis and received non-operative management were re-evaluated retrospectively. Defining uncomplicated appendicitis was based on the duration of symptoms (<24 hours), clinical history, and radiologic findings. The radiologic evaluation was based on ultrasonography and computed tomography. The patients received an intravenous antibiotic combination (sulbactam/ampicillin, gentamicin, clindamycin) for five days at the hospital; the treatment was completed after 10 days with an oral antibiotic combination (amoxicillin/clavulanate, metronidazole). The cases have a follow-up period of up to two years. Results: The mean patient age and follow-up time were 10,42±3,65 years and 30,15±5 months, respectively. The mean leukocyte count, C-reactive protein (CRP), and appendix diameter values were 15,82±5,4×109/L, 20,38±33,4mg/dL, and 7.87±1.4 mm on admission. None of the patients had an early failure, complication, or adverse event. Recurrent appendicitis occurred in only one case (4%) that was treated by laparoscopic appendectomy during the follow-up. Conclusion: Non-operative management for acute uncomplicated appendicitis in children regarding long-term outcomes with our criteria was satisfactory and initial success rates were excellent.

Keywords

• Acute appendicitis
• appendectomy
• children
• conservative treatment
• non-operative management

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