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      The treatment of complicated appendicitis in children. What is the gold standard?

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          Abstract

          From 1976 to 1985, 233 consecutive children were treated for appendicitis by a standardized protocol. Forty-nine percent of these cases were complicated: 11% by gangrene, 33% by perforation, and 4% by perforations with well-developed abscesses. Treatment of gangrenous and perforated appendicitis consisted of administration of ampicillin sodium, gentamicin sulfate, and clindamycin phosphate; appendectomy; and saline peritoneal irrigation. Transperitoneal drainage was not used. Skin and subcutaneous tissues were left open for delayed primary wound closure. Perforations with well-developed abscesses were treated with triple antibiotic therapy and interval appendectomy. The only infectious complication was one intra-abdominal abscess. There were no wound infections or deaths. The rate of infectious complications was 0.9%, and the overall morbidity was 4.4%. This standardized treatment of complicated appendicitis in children prevents wound infection and significantly decreases the incidence of intra-abdominal abscess formation and mortality.

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          Author and article information

          Journal
          Arch Surg
          Archives of surgery (Chicago, Ill. : 1960)
          American Medical Association (AMA)
          0004-0010
          0004-0010
          Apr 1987
          : 122
          : 4
          Article
          10.1001/archsurg.1987.01400160050006
          3566525
          60dacb5f-e321-4329-9982-72b26dc7681d

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