Lots of studies in adults and children, mainly done in HICs, are advocating antibiotics only (conservative) management of acute non-perforated appendicitis. In LMICs, with poor access to healthcare, most patients present with perforation. Is there a role of conservative management of acute non-perforated appendicitis in children in LMICs?
The role of conservative management of acute non perforated appendicitis in children is fairly well established (Jumah S, Wester T. Non-operative management of acute appendicitis in children. Pediatr Surg Int. 2022 Nov 28;39(1):11. doi: 10.1007/s00383-022-05284-y. PMID: 36441297
Armstrong J, Merritt N, Jones S, Scott L, Bütter A. Non-operative management of early, acute appendicitis in children: is it safe and effective? J Pediatr Surg. 2014 May;49(5):782-5. doi: 10.1016/j.jpedsurg.2014.02.071. Epub 2014 Feb 22. PMID: 24851770).
With special reference to the same in the setting of LMIC, the COVID pandemic has brought an increased thrust of its use (Hannan MJ, Parveen MK, Hoque MM, Chowdhury TK, Hasan MS, Nandy A. Management of Acute Appendicitis in Children During COVID-19 and Perspectives of Pediatric Surgeons From South Asia: Survey Study. JMIR Perioper Med. 2021 Dec 21;4(2):e26613.). The evidence for its successful implementation is worth the effort with appropriate inclusion / choice of cases.
Unpublished data from our centre supports the use of non operative management in children with early presentation (onset of pain within 2-3 days), absence of significant collection, fecolith on imaging and successful resolution of symptoms by 24 hours of antibiotics.
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