What could be more quintessential pediatrics than diagnosing a child with an acute appendicitis, admitting the child to the hospital, and preparing the family for a surgical procedure to remove the diseased appendix with an operation? This is the way it has been done during my entire pediatric career and for the past 100 years… until recently when the winds of change are blowing fast and hard. First came the advent of laprascopic, minimally invasive appendectomies, now commonly used in skilled hands to remove a sick appendix. Just a few pokes in the abdomen for lights, cameras, and instruments, and out comes the diseased appendix. Amazing.
If that wasn’t enough, now surgeons are actually treating an acute appendicitis with antibiotics and not surgery. Pediatric surgeons in Charlotte and elsewhere have discovered that some IV and oral antibiotics, during the early for children with uncomplicated non ruptured appendices actually recover faster and have less missed school than those that were treated with the standard appendix removal operation.
While the initial research is promising for the antibiotic approach, pediatric surgeons caution it is not for every child with an acute appendicitis. The child’s sick appendix needs to have not ruptured, be non obstructed, and be not too swollen and sick. If you and your child’s doctors catch things early enough however, the antibiotic approach might be a great option for their care. If your child is unfortunate enough to have an inflamed appendix one day, having a treatment other than surgical removal may be a great option to take care of their problem. Now that’s what I call progress.
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Written by Paul Smolen M.D.