Management of an acute appendicitis is surgical. Delaying appendicectomy however, does not increase the risk of complicated appendicitis once intravenous antibiotics are administered. Also, delaying appendicectomy for >6 h after admission demonstrated no differences in surgical site infection (SSI) or perforation rates compared with immediate appendicectomy.
Non-operative management is an appropriate treatment option for “selected children” with acute appendicitis, under surgical guidance
It includes intravenous fluids, parenteral nutrition(if the child is unable to eat after one week), antibioticstill the child is afebrile, tolerating a regular diet, and has a normal WBC and appropriate pain management.
Indications for intervention in those being managed conservatively are - lack of clinical improvement within 24 to 48 hours, continued fever, worsening of localized tenderness, and increase in size of abdominal mass.
Non-operative management of acute appendicitis with an appendicolith, has an unacceptably high failure rate in children.
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