Determination of follow-up criteria for uncomplicated appendicitis treated with nonoperative antibiotherapy in children

Aim of the study: In our study, we aimed to determine the follow-up criteria in our patients who were diagnosed with acute appendicitis and treated without surgery, which were not adequately presented in the literature. Methods: After intravenous administration of ceftriaxone and metronidazole for 5 days, oral amoxicillin-clavunate was started in children with acute appendicitis. Tenderness, defense and rebound were evaluated by examining the patients twice a day for 7 days. On the 1st, 2nd, 3rd and 7th days of the follow-up, white blood cell count (WBC), neutrophil percentages, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6) and pentraxin-3 (PTX-3) values were measured, and the diameter and wall thickness of the appendix were evaluated by abdominal ultrasonography (USG). Results: A total of 24 patients were included in the study. In the follow-up of the patients, the physical examination findings regressed significantly (p<0.001). While there was a statistically significant decrease in mean white blood cell count, percentage of neutrophils, CRP and procalcitonin values after the first day, the decrease in IL-6 and PTX-3 values was not significant. On ultrasonography, a significant decrease was observed in the mean appendix wall thickness and diameter after the second day. Two patients were operated on with recurrent abdominal pain and detection of appendicolith (in one patient) after discharge. The remaining 22 patients were successfully treated and followed up with hospital and telephone visits for about 2 years. No problems were detected. Conclusions: Conservative treatment is successful in acute appendicitis. Tenderness, defense and rebound findings, leukocyte count, CRP and procalcitonin serum values, and appendix wall thickness and diameter, which decrease from the 2nd day of treatment, are helpful in the evaluation of the patient as follow-up criteria. On the 7th day of treatment, signs and values normalize. In this way, a follow-up protocol can be created. Key words: Pediatric Appandicitis, Conservative treatment, Treatment with antibioteraphy, Treatment protocol