{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T22:59:56Z","timestamp":1773442796803,"version":"3.50.1"},"reference-count":48,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Simple appendicitis may be self-limiting or require antibiotic treatment or appendectomy. The aim of this study was to assess the feasibility and safety of a nonoperative, antibiotic-free approach for suspected simple appendicitis in children. Methods: This single-center, retrospective study included patients (0\u201317 years old) who were hospitalized at the pediatric surgery department due to suspected appendicitis between 2011 and 2012. Data from patients who primarily underwent appendectomy were used as controls. The follow-up of nonoperatively managed patients was conducted in 2014. The main outcome of interest was appendicitis recurrence. Results: A total of 365 patients were included: 226 were treated conservatively and 139 underwent appendectomy. Fourteen (6.2% of 226) of the primarily nonoperatively treated patients required secondary appendectomy during follow-up, and histology confirmed simple, uncomplicated appendicitis in 10 (4.4% of 226) patients. Among a subset of 53 patients managed nonoperatively with available Alvarado and\/or Pediatric Appendicitis Scores and sonographic appendix diameters in clinical reports, 29 met the criteria for a high probability of appendicitis. Three of these patients (10.3% of 29) underwent secondary appendectomy. No complications were reported during follow-up. Conclusions: A conservative, antibiotic-free approach may be considered for pediatric patients with suspected uncomplicated appendicitis in a hospital setting. Only between 6 and 10% of these patients required secondary appendectomy. Nevertheless, the cohort of patients treated nonoperatively was likely to have also included individuals with further abdominal conditions other than appendicitis. Active observation and clinical support during the disease course may help patients avoid unnecessary procedures and contribute to spontaneous resolution of appendicitis or other pediatric conditions as the cause of abdominal pain. However, further studies are needed to define validated diagnostic and management criteria.<\/jats:p>","DOI":"10.3390\/children11030340","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T13:23:11Z","timestamp":1710336191000},"page":"340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5479-469X","authenticated-orcid":false,"given":"Patricia","family":"Reis Wolfertstetter","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Blanford","family":"Ebert","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medbo Bezirksklinikum Regensburg, Universitaetsstrasse 84, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Barop","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Medbo Bezirksklinikum Regensburg, Universitaetsstrasse 84, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1580-0273","authenticated-orcid":false,"given":"Markus","family":"Denzinger","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Orthopedics, Hospital St. Hedwig of the Order of St. John of God, University Children\u2019s Hospital Regensburg (KUNO), Steinmetzstrasse 1-3, 93049 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1119-7174","authenticated-orcid":false,"given":"Michael","family":"Kertai","sequence":"additional","affiliation":[{"name":"Section of Pediatric Orthopedics, Department of Orthopedics and Trauma Surgery, Hospital St. Marien Amberg, Mariahilfberg 7, 92224 Amberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3874-0296","authenticated-orcid":false,"given":"Hans J.","family":"Schlitt","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Alee 11, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7146-780X","authenticated-orcid":false,"given":"Christian","family":"Knorr","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Orthopedics, Hospital St. Hedwig of the Order of St. John of God, University Children\u2019s Hospital Regensburg (KUNO), Steinmetzstrasse 1-3, 93049 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1053\/j.sempedsurg.2006.10.005","article-title":"Current management of appendicitis","volume":"16","author":"Morrow","year":"2007","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_2","unstructured":"Hontschik, B. (2012). Kurze Geschichte der Appendektomie: Mythen, Fakten, Perspektiven, Marseille-Verlag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines","volume":"15","author":"Podda","year":"2020","journal-title":"World J. Emerg. Surg. WJES"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1056\/NEJMoa2014320","article-title":"A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis","volume":"383","author":"Flum","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8933","DOI":"10.1007\/s00464-023-10456-5","article-title":"Diagnosis and treatment of appendicitis: Systematic review and meta-analysis","volume":"37","author":"Lamm","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/SLA.0000000000000835","article-title":"Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: A pilot randomized controlled trial","volume":"261","author":"Svensson","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/s-0032-1320014","article-title":"A review of conservative treatment of acute appendicitis","volume":"22","author":"Svensson","year":"2012","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s40137-018-0207-8","article-title":"The Criteria for Treating Appendicitis Non-operatively","volume":"6","author":"Lawrence","year":"2018","journal-title":"Curr. Surg. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Decker, E., Ndzi, A., Kenny, S., and Harwood, R. (2023). Systematic Review and Meta-analysis to Compare the Short- and Long-term Outcomes of Non-operative Management with Early Operative Management of Simple Appendicitis in Children After the COVID-19 Pandemic. J. Pediatr. Surg.","DOI":"10.1016\/j.jpedsurg.2023.12.021"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s13063-018-2520-z","article-title":"CONTRACT Study\u2014CONservative TReatment of Appendicitis in Children (feasibility): Study protocol for a randomised controlled Trial","volume":"19","author":"Hutchings","year":"2018","journal-title":"Trials"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1136\/archdischild-2017-313127","article-title":"Conservative treatment versus surgery for uncomplicated appendicitis in children: A systematic review and meta-analysis","volume":"102","author":"Kessler","year":"2017","journal-title":"Arch. Dis. Child."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1097\/SLA.0000000000003225","article-title":"Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children: A Systematic Review and Meta-analysis","volume":"270","author":"Podda","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"631","DOI":"10.14744\/nci.2022.67984","article-title":"Prevalence of appendicolith in children with acute appendicitis and its correlation with disease severity","volume":"10","author":"Oktay","year":"2023","journal-title":"North. Clin. Istanb."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00383-016-3990-2","article-title":"Pediatric appendicitis: State of the art review","volume":"33","author":"Rentea","year":"2017","journal-title":"Pediatr. Surg. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1053\/j.semdp.2004.11.003","article-title":"Appendicitis and infections of the appendix","volume":"21","author":"Lamps","year":"2004","journal-title":"Semin. Diagn. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S1092-9134(00)90011-X","article-title":"The pathology of acute appendicitis","volume":"4","author":"Carr","year":"2000","journal-title":"Ann. Diagn. Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1055\/s-0035-1570756","article-title":"The Usefulness of Combined B Mode and Doppler Ultrasonography to Guide Treatment of Appendicitis","volume":"26","author":"Ohba","year":"2016","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1002\/bjs.10660","article-title":"Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis","volume":"104","author":"Park","year":"2017","journal-title":"Br. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s00268-006-0056-y","article-title":"The natural history and traditional management of appendicitis revisited: Spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis","volume":"31","author":"Andersson","year":"2007","journal-title":"World J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/s00268-016-3489-y","article-title":"Does Delay of Diagnosis and Treatment in Appendicitis Cause Perforation?","volume":"40","author":"Andersson","year":"2016","journal-title":"World J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/S0140-6736(15)00275-5","article-title":"Acute appendicitis: Modern understanding of pathogenesis, diagnosis, and management","volume":"386","author":"Bhangu","year":"2015","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1197\/aemj.9.4.281","article-title":"A randomized clinical trial of analgesia in children with acute abdominal pain","volume":"9","author":"Kim","year":"2002","journal-title":"Acad. Emerg. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1542\/peds.2005-0273","article-title":"Early analgesia for children with acute abdominal pain","volume":"116","author":"Green","year":"2005","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/j.jpedsurg.2017.12.012","article-title":"Outcome of initially nonoperative treatment for acute simple appendicitis in children","volume":"53","author":"Gorter","year":"2018","journal-title":"J. Pediatr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"662183","DOI":"10.3389\/fped.2021.662183","article-title":"Using Machine Learning to Predict the Diagnosis, Management and Severity of Pediatric Appendicitis","volume":"9","author":"Marcinkevics","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/S0196-0644(86)80993-3","article-title":"A practical score for the early diagnosis of acute appendicitis","volume":"15","author":"Alvarado","year":"1986","journal-title":"Ann. Emerg. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1053\/jpsu.2002.32893","article-title":"Pediatric appendicitis score","volume":"37","author":"Samuel","year":"2002","journal-title":"J. Pediatr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/PEC.0b013e31820d6460","article-title":"Prospective validation of two systems of classification for the diagnosis of acute appendicitis","volume":"27","author":"Gamell","year":"2011","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e88","DOI":"10.1542\/peds.2013-2208","article-title":"Prospective evaluation of a clinical pathway for suspected appendicitis","volume":"133","author":"Saucier","year":"2014","journal-title":"Pediatrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e9518","DOI":"10.1097\/MD.0000000000009518","article-title":"The intra- and extraluminal appendiceal microbiome in pediatric patients: A comparative study","volume":"96","author":"Schlichting","year":"2017","journal-title":"Medicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1007\/s00104-002-0437-1","article-title":"Die chronische Appendizitis als eigenst\u00e4ndige klinische Entit\u00e4t","volume":"73","author":"Mussack","year":"2002","journal-title":"Chirurg"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Juki\u0107, M., Nizeteo, P., Matas, J., and Pogoreli\u0107, Z. (2023). Trends and Predictors of Pediatric Negative Appendectomy Rates: A Single-Centre Retrospective Study. Children, 10.","DOI":"10.3390\/children10050887"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1055\/s-0032-1320017","article-title":"Imaging and the use of scores for the diagnosis of appendicitis in children","volume":"22","author":"Dingemann","year":"2012","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/S2352-4642(20)30006-7","article-title":"Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): A prospective, multicentre validation study","volume":"4","author":"Nepogodiev","year":"2020","journal-title":"Lancet Child. Adolesc. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1177\/000313481107700633","article-title":"Efficacy of short-term antibiotic therapy for consecutive patients with mild appendicitis","volume":"77","author":"Park","year":"2011","journal-title":"Am. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s00247-022-05497-2","article-title":"Follow-up ultrasonographic findings among children treated conservatively for uncomplicated acute appendicitis","volume":"53","author":"Stackievicz","year":"2023","journal-title":"Pediatr. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1136\/bmj.308.6921.107","article-title":"Indications for operation in suspected appendicitis and incidence of perforation","volume":"308","author":"Andersson","year":"1994","journal-title":"BMJ"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"zraa045","DOI":"10.1093\/bjsopen\/zraa045","article-title":"Use of gene expression profiling to identify candidate genes for pretherapeutic patient classification in acute appendicitis","volume":"5","author":"Kiss","year":"2021","journal-title":"BJS Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1148\/radiology.205.1.9314962","article-title":"Spontaneously resolving acute appendicitis: Clinical and sonographic documentation","volume":"205","author":"Migraine","year":"1997","journal-title":"Radiology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1001\/jamapediatrics.2017.0057","article-title":"Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children: A Meta-analysis","volume":"171","author":"Huang","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1093\/bjs\/znac086","article-title":"Antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis (APPAC III): Randomized double-blind superiority trial","volume":"109","author":"Salminen","year":"2022","journal-title":"Br. J. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/j.jtbi.2007.08.032","article-title":"Biofilms in the large bowel suggest an apparent function of the human vermiform appendix","volume":"249","author":"Barbas","year":"2007","journal-title":"J. Theor. Biol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Petruzziello, C., Saviano, A., and Ojetti, V. (2023). Probiotics, the Immune Response and Acute Appendicitis: A Review. Vaccines, 11.","DOI":"10.3390\/vaccines11071170"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1136\/archdischild-2020-320746","article-title":"CONservative TReatment of Appendicitis in Children: A randomised controlled feasibility Trial (CONTRACT)","volume":"106","author":"Hall","year":"2021","journal-title":"Arch. Dis. Child."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1016\/j.jpedsurg.2015.06.002","article-title":"Carcinoid tumours of the appendix in children having appendicectomies at Princess Margaret Hospital since 1995","volume":"50","author":"Vandevelde","year":"2015","journal-title":"J. Pediatr. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.jpedsurg.2017.03.012","article-title":"Surgical management and surveillance of pediatric appendiceal carcinoid tumor","volume":"52","author":"Lobeck","year":"2017","journal-title":"J. Pediatr. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Pogoreli\u0107, Z., Ercegovi\u0107, V., Ba\u0161kovi\u0107, M., Juki\u0107, M., Karaman, I., and Mrkli\u0107, I. (2023). Incidence and Management of Appendiceal Neuroendocrine Tumors in Pediatric Population: A Bicentric Experience with 6285 Appendectomies. Children, 10.","DOI":"10.3390\/children10121899"},{"key":"ref_48","first-page":"103042","article-title":"Interpretable and intervenable ultrasonography-based machine learning models for pediatric appendicitis","volume":"91","author":"Klimiene","year":"2023","journal-title":"Med. Image Anal."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/3\/340\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:12:47Z","timestamp":1760105567000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/3\/340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,13]]},"references-count":48,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["children11030340"],"URL":"https:\/\/doi.org\/10.3390\/children11030340","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,13]]}}}