Management of complicated pediatric appendicitis: Where we've been and where we're going.

Complicated appendicitis, in which the appendix has perforated, is a well-studied pediatric surgical condition. Despite this, practice management varies widely among institutions. Both suspected and confirmed perforation present unique challenges beyond those of acute uncomplicated appendicitis, namely increased healthcare utilization and a higher incidence of postoperative abscess. Debate continues regarding the role and timing of appendectomy, as well as antibiotic choice and duration to mitigate these challenges. There are developing new initiatives that target different aspects of management in the hopes of reducing overall morbidity and sequela. In this article, we discuss the history and current management of complicated appendicitis in children, along with emerging developments in the field.