700 Children's® – A Blog by Pediatric Experts

Non-Surgical Appendicitis Treatment Gives Parents Options

Sep 10, 2020
Child holding his stomach in pain

Typically, when most parents hear the word appendicitis, they also hear the word surgery. Appendectomies have been performed safely for decades and are a proven treatment for appendicitis. But what if there was another treatment option that didn’t require surgery? If your child qualified, what if their appendicitis could be treated with antibiotics alone?

Our doctors have studied treatment of uncomplicated appendicitis — and how patients and families choose between surgical and antibiotics only treatment options — for nearly 10 years. In our recent study, we found that children with uncomplicated appendicitis who elected to do so could be successfully sent home without surgery. They experienced less pain and no harmful side effects and did not later require an appendectomy by their one-year follow-up.

Children who were treated with antibiotics also experienced nearly four fewer “sick days” at home on average than those who underwent surgery. Their caregivers required less of this time as well. For you and your child, this could mean fewer days of missed school, work, vacations, athletics or other activities.

In Our Study:

  • 1,068 patients and families participated.
  • Patients were children 7-17 years old.
  • 370 patient families chose antibiotics alone.
  • 698 patient families chose surgery.
  • Patients in the non-surgery group were admitted to the hospital and received IV antibiotics for at least 24 hours, followed by oral antibiotics for a total of 70 days after discharge.
  • Among those patients, there was a 67.1% success rate.
  • 9 other children’s hospitals across 7 states also participated in this research.

In Order to Be a Candidate for the Study, Patients Needed To:

  • Have uncomplicated appendicitis, meaning abdominal pain for only 48 hours,
  • Have a white blood cell count less than 18,000,
  • Undergo an ultrasound or CT scan to rule out rupture and to verify that their appendix was 1.1 centimeter thick or smaller, and
  • Have no evidence of an abscess or fecalith (a hard, stone-like piece of stool).

The most important facet of this study is the ability of patients and their families to choose their treatment. If a child is eligible, the family ultimately gets to decide whether they prefer antibiotics or surgery based on what is important to them. There is no right or wrong decision when it comes to treatment — both options have advantages and challenges. In fact, in the study, the patients who chose surgery and those who chose only antibiotics both reported similar satisfaction with their care after one month and similar quality of life after one year.

Even armed with the same information about these pros and cons, patients and families may come to different decisions about treatment options based on what’s right for and important to them. As families consider surgery or antibiotics, they may, for example, consider whether there is a chance that the appendicitis could come back again or whether there are risks of bleeding or infection. A family who is averse to surgery, wants to avoid “sick days” or has cultural beliefs that align with avoiding surgery may choose antibiotics, while a patient who has been transferred from another hospital may choose surgery.

Additionally, for the study, surgeons and researchers ranked some complications from treatment options as “minor” and others as “major.” However, to your family, any complications may be simply that — complications, not major or minor — because any post-treatment complication might be equally disruptive to your family’s experience and quality of life.

If your child develops right lower-quadrant pain, it is important to see a doctor. Call your pediatrician or come into the hospital where an imaging study will be able to tell you whether your child has early appendicitis and if he/she might be a candidate for antibiotics only treatment.

You’re a part of your child’s care team. Involving families in making decisions about treatment options like these ensures the patient and the family are comfortable with everything that happens before, during and after treatment.

As with any decision about your child’s health, it is important to present any questions or concerns to your child’s pediatrician to ensure that you understand and are comfortable with the choice you make.

Featured Expert

Katherine Deans
Katherine Deans, MD
Center for Innovation in Pediatric Practice

Katherine Deans, MD is board certified by the American Board of Surgery in Surgery, Surgical Critical Care and Pediatric Surgery. She is a member of the American College of Surgeons, Society of Critical Care Medicine and the American Pediatric Surgical Association.

Peter Minneci
Peter Minneci, MD
Center for Innovation in Pediatric Practice

Dr. Minneci is board certified by the American Board of Surgery in Surgery and Surgical Critical Care and is a member of the American College of Surgeons, Society of Critical Care Medicine and Alpha Omega Alpha.

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Pediatric News You Can Use From America’s Largest Pediatric Hospital and Research Center

700 Children’s® features the most current pediatric health care information and research from our pediatric experts – physicians and specialists who have seen it all. Many of them are parents and bring a special understanding to what our patients and families experience. If you have a child – or care for a child – 700 Children’s was created especially for you.