Efficacy and safety of the conservative management of appendiceal phlegmon during childhood.

Objective: To assess the efficacy and safety of conservative management with interval appendectomy vs. baseline surgery in the treatment of appendiceal phlegmon.

Material and methods: A retrospective study of the 76 phlegmons treated from July 2016 to June 2024 was carried out. Two treatment groups were created -the baseline surgery (G1: 46 children) group and the conservative with interval appendectomy (G2: 30 children) group. Clinical and progression characteristics of both groups were collected and compared.

Results: No significant differences were found in terms of age, progression time, presence of appendicolith, or mean hospital stay. The number of intra-abdominal collections at diagnosis was greater in G2 (21.7% vs. 56.6%; p< 0.05), and the percentage of complications was significantly higher in G1 (54.34% vs. 20%; p< 0.002). In G2, 3 collection drainage procedures were carried out, and 4 children underwent surgery in an acute stage as a result of treatment failure. Following discharge, 2 patients from G2 underwent emergency surgery, 4 refused surgery, and 20 underwent surgery after 184 ± 55 days. Of the latter, 2 had complications. 89.47% of the appendices removed had histological disorders.

Conclusions: Conservative treatment of appendiceal phlegmon is safe and effective. It significantly reduces morbidity, and it is not contraindicated by age, presence of appendicolith, or intra-abdominal collections. However, large collection drainage procedures may be required. We believe interval appendectomy is indicated in a period of 3-6 months.