Efficacy and safety of the conservative management of appendiceal phlegmon during childhood.

OBJECTIVE

To assess the efficacy and safety of conservative management with interval appendectomy vs. baseline surgery in the treatment of appendiceal phlegmon.

MATERIAL AND

METHODS

A retrospective study of the 76 phlegmons treated from July 2016 to June 2024 was carried out. Two treatment groups were created -the baseline surgery (G1: 46 children) group and the conservative with interval appendectomy (G2: 30 children) group. Clinical and progression characteristics of both groups were collected and compared.

RESULTS

No significant differences were found in terms of age, progression time, presence of appendicolith, or mean hospital stay. The number of intra-abdominal collections at diagnosis was greater in G2 (21.7% vs. 56.6%; p< 0.05), and the percentage of complications was significantly higher in G1 (54.34% vs. 20%; p< 0.002). In G2, 3 collection drainage procedures were carried out, and 4 children underwent surgery in an acute stage as a result of treatment failure. Following discharge, 2 patients from G2 underwent emergency surgery, 4 refused surgery, and 20 underwent surgery after 184 ± 55 days. Of the latter, 2 had complications. 89.47% of the appendices removed had histological disorders.

CONCLUSIONS

Conservative treatment of appendiceal phlegmon is safe and effective. It significantly reduces morbidity, and it is not contraindicated by age, presence of appendicolith, or intra-abdominal collections. However, large collection drainage procedures may be required. We believe interval appendectomy is indicated in a period of 3-6 months.