Non Operative Management of Complicated Appendicitis with Broad Spectrum Antibiotics in a Paediatric Patient: A Case Report

Abstract

The therapy for complicated appendicitis presents a clinical challenge, as it is characterised by inflammation with a contained or localised perforation that results in the formation of an abscess. This case report describes the presentation, diagnosis, and effective non operative management of a 14-year-old girl with acute complex appendicitis. Investigations and clinical examination confirmed the presence of an appendicular abscess in the patient, who exhibited characteristic symptoms. The treatment course adhered to the Ochsner-Sherren protocol, which included fluid resuscitation, broad-spectrum intravenous antibiotics, and a Nil Per Oral (NPO) status. An ultrasound-guided aspiration of periappendicular pus indicated that an empirical upgrade to Piperacillin + Tazobactam was necessary. The patient showed improvement in all symptoms, including fever and abscess resolution, after the switch in antibiotics. This case adds to the increasing body of research that supports non operative therapy for complex appendicitis, particularly when assisted by diagnostic tools such as ultrasonography. The decision to forego emergency surgery aligns with current evidence advocating for conservative strategies, which demonstrate higher success rates and lower risks of postoperative complications. Although appendectomy remains the preferred treatment for perforated appendicitis without an abscess, this case highlights the viability and effectiveness of non operative interventions in certain situations. This report emphasises the significance of customised treatment strategies based on patient presentation and clinical response, contributing to the ongoing discussion regarding the best therapy for complex appendicitis.

Keywords

• ochsner-sherren regimen
• piperacillin-tazobactam
• surgery
• vermiform appendix