الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Acute appendicitis is the most common emergency that occurs in children and adolescents. Diagnosis of acute appendicitis is very difficult specially in the pediatric age group. Delay in diagnosis of acute appendicitis may lead to many complications e.g. peritonitis, perforation, appendicular abscess. Differential diagnosis of suspected AA in children is quite difficult and may result in an increased rate of negative appendectomies. The diagnosis of pediatric AA remains challenging. Some clinical scores are evolved to help diagnosis of AA. They mainly depend on 1- good history taking, 2- physical examination, 3- laboratory findings (TLC, CRP). The ideal clinical score could accurately distinguish between patients who need immediate operative care and patients who may be postponed to have further investigation or observation. PAS is commonly used in children. Treatment is traditionally surgical. However, an alternative approach to treat acute uncomplicated appendicitis in children with antibiotics and without an appendectomy has established a tremendous momentum in the past few years. The aim of this study was to evaluate the safety and outcome of conservative treatment of uncomplicated appendicitis in children. The main outcomes were the response to conservative treatment, complications during the course of this treatment and short term recurrence of appendicitis in initial responders to treatment. Our study included 100 children aged 4-18 years, diagnosed with AUA who were admitted to the Pediatric Surgery Unit, Tanta University Hospitals during the period from 2/2021 to 9/2022. They were diagnosed using PAS, pelviabdominal ultrasound and CRP levels. According to interpretation of PAS we excluded patients with PAS ≤ 3. We included children whose PAS is 7-10. The children whose PAS was 4-6 were included if their ultrasound report showed positive findings of AUA. Assessment of the Patients was done using PAS: Pediatric Appendicitis Score (PAS) Items: (Samuel M, 2002) (3) - Anorexia (refusal of feeding 1 - Nausea or vomiting. 1 - Tenderness over right lower quadrant on light palpation 2 - Cough / Percussion tenderness over right lower quadrant 2 - Low grade fever ≥ 38 o C. 1 - Leucocytosis > 10. 000 1 - - Neutrophilia (shift to left) (more than 70% of TLC) 1 - Migration of pain to Right Lower quadrant 1 - Total 10 Grading of score: 0−3 low risk of appendicitis. 4−6 medium risk. 7−10 high risk. In our series NOM depended mainly on intra venous (IV) 3rd generation cephalosporin (Cefepime) in a dose of 100 mg/kg BW/day in two divided doses, and metronidazole in a dose of 7.5mg/kg every 8h. Analgesics were prescribed according to patient general condition to control pain, starting with paracetamol. In patients still having pain nonsteroidal antiinflammatory analgesic (e.g. Adolor) was added. Oral intake was restricted only in patients who had severe GIT symptoms. Once the patient can tolerate oral intake, feeding was gradually introduced, shifting to oral 3rd generation cephalosporins and oral metronidazole at home for 5 days. In our study the duration of symptoms was 1-5 days in children who ad successful NOM. While it was 1-7 days in patients who failed NOM. However, there was no statistical significance. The success rate of NOM in our series was 84%. Most cases showed improvement of both clinical & laboratory findings on 2nd day of management. We followed up our cases who had successful NOM for any relapse at one week, 6weeks, 3months then 6months. Readmission for cases who had a relapse occurred in 4 cases, one case relapsed after 6 weeks of discharge, patient failed conservative treatment and was operated laparoscopy. Another 2 cases were readmitted with arelapse after 3 months and one case after 6 months. They were managed conservatively again, and responded to NOM. A cording to the total cost in our series, there was higher costs of operated cases than NOM patients. In conclusion: Using conservative management of AUA among children aged 4-18 years, proved to be safe, effective and have a low rate of complications. It reduced the negative appendectomy rate to 1%. It is associated with a low relapse rate within 6 months and significantly reduces the treatment cost. With parents counseling, the parents can accept the NOM and had their fear alleviated. However a controlled randomized trial on a bigger number of cases is needed to validate these results.