High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

Background: The purpose of this study was to investigate the feasibility of nonoperative management of acute appendicitis in children with an appendicolith identified on preoperative imaging. Study design: We performed a prospective nonrandomized trial of nonoperative management of uncomplicated acute appendicitis with an appendicolith in children aged 7 to 17 years. The primary outcome was the failure rate of nonoperative management, defined as having undergone an appendectomy. Early termination was set to occur if the lower limit of the 95% confidence interval of the failure rate was greater than 20% at 30 days or 30% at 1 year. Results: Recruitment for this study was halted after enrollment of 14 patients (N = 5 nonoperative; N = 9 surgery). The failure rate of nonoperative management was 60% (3/5) at a median follow-up of 4.7 months (IQR 1.0-7.6) with a 95% CI of 23%-88%. None of the three patients that failed nonoperative management had complicated appendicitis at the time of appendectomy, while six out of nine patients who chose surgery had complicated appendicitis (0/3 vs. 6/9, p = 0.18). The trial was stopped for concerns over patient safety. Conclusions: Nonoperative management of acute appendicitis with an appendicolith in children resulted in an unacceptably high failure rate. (C) 2016 Elsevier Inc. All rights reserved.