الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
Our study was conducted on pediatric patients who have been diagnosed to have acute non-complicated appendicitis after their presentation to Suez Canal University Hospital. Diagnosis of non-complicated acute appendicitis was based on clinical, laboratory and radiological diagnosis.
Our study population included 124 children with age range (4-12) years who were eligible to strict inclusion and exclusion criteria and were managed by non-operative treatment protocol with antibiotics for 48 hours. Patients who improved were discharged on oral antibiotic treatment and were followed up for detection of recurrence and possible appendectomies. Failure to improve within the first 48 hours of medical treatment or worsening of the condition at any time were the end points for non-operative treatment and patients in this case proceeded to appendectomy.
After statistical analysis about (88.7%) of patients showed initial relief of symptoms and were discharged and after 1 year of follow up the success rate of the treatment protocol was found to be (79%) with no significant complication to the patients even those who underwent appendectomy.
Our study concluded predictive factors of failure of non-operative treatment such as high fever, abdominal rigidity, high modified Alvarado score and high appendiceal diameter at time of presentation. All these factors were significantly correlated with failure of treatment initially and readmission at follow up alike.
Patients with modified Alvarado score of (9) or higher should be excluded of non-operative approach as patients with this score showed total failure of this approach.
We conclude that non-operative treatment protocol used in this study to manage non-complicated pediatric acute appendicitis is safe and feasible and should be considered as alternative to surgery in selected cases. However, strict criteria should be placed when applying non-operative treatment to early diagnose complication and avoid potential risks.