In/exclusie criteria

Inclusion criteria

• Age 7-17 years

• Radiologically confirmed simple appendicitis, defined as:

a. Clinical findings:
i. Unwell, but not generally ill
ii. Localized tenderness in the right iliac fossa region
iii. Normal/hyperactive bowel sounds
iv. No guarding
v. No mass palpable

b. Ultrasonography
i. Incompressible appendix with an outer diameter of ≥6 mm
ii. Hyperaemia within the appendiceal wall
iii. Without faecolith
iv. Infiltration of surrounding fat
v. No signs of perforation
vi. No signs of intra-abdominal abscess/phlegmon

Exclusiecriteria:

1. Patients with severe general illness at time of presentation:

a. Generalized peritonitis defined as:
clinical signs consisting of increasing abdominal pain, generalized tenderness, diffuse abdominal rigidity, sinus tachycardia, and signs of paralytic ileus.
b. Severe sepsis or septic shock.  (See tabel)

c. Clinical prediction score (See clinical prediction rule below): 

  • Score < 4: Inclusie
  • Score 4 or 5: Bel onderzoeker: Max Knaapen 06-20979124
  • Score > 5: Exclusie

2. Children with a faecolith on ultrasonography.

3. Patients with serious associated conditions or malformations such as:
a. Congenital or acquired cardiac or pulmonary disease with significant
hemodynamic consequences
b. Immunodeficiency
c. Malignancy
d. Homozygous sickle cell disease
e. Metabolic disorders

4. Patients with documented type 1 allergy to the antibiotics used
5. Patients who have been treated for acute simple appendicitis non-operatively in the past year.
6. Patients with a suspicion of an underlying malignancy based upon clinical and
radiological evaluation.

Echo standaard checklist

OmschrijvingSimpele appendicitisGecompliceerde appendicitis
Is de appendix a vue?XX
Dikte van de appendix: .....................mm(>6mm)
Is de appendix oncomprimeerbaar?X
Is de appendix pijnlijk gedurende het onderzoek?X
Wat is de bloodflow in de appendix:
Normaal / Hyperemisch
Hyperemisch
Is er sprake van vetinfiltratie rondom de appendix?X
Is er sprake van vrij vocht?

Karakteristieken van het vocht:
Soort vocht: Helder / Troebel
Geen/spoortje (<1 cm max. diameter)Veel (>1cm max. diameter) Troebel
Aanwijzingen voor paralytische ileus?
(multiple verwijde darmlissen met vocht)
X
Is er een faecoliet aanwezig?X
Is er sprake van een peri-appendiculair infiltraat?X
Is er sprake van extraluminaal gas/lucht?X
Is er sprake van diffuus of lokaal verlies van de echogene submucosale laag van de appendix?X
Is er sprake van een abces?X
Uiteindelijke diagnose:
Simpele appendicitis / geen simpele appendicitis

Clinical prediction rule

DeterminantsAwarded points
Final model
Diffuse abdominal guarding3
CRP level more than 38 mg/L2
"Signs indicative of complex appendicitis" On ultrasound2
>1 day of abdominal pain2
Temperature > 37.5 degree Celsius1
Score < 3Inclusie
Score 4 or 5Bel onderzoeker: Max Knaapen 06-20979124 of Paul van Amstel 06-14450302
Score > 5Exclusie