Pediatric Surgery Experts Discuss Delayed Treatment of Ruptured Appendix

What I would say is that it is extremely rare to have a child of this age with perforated appendicitis, and that it would certainly not be high on any pediatric surgeon’s differential upon a child’s initial presentation to an ER with these symptoms. However, if the child was deteriorating over the ensuring days, then perhaps a consideration for going to the operating room should have been entertained based on the child’s exam and clinical status. Once committed to going to the operating room, most surgeons would still not expect to be finding appendicits in this scenario, but probably had they gone to the operating room based on other clinical findings, then this may have avoided additional injuries. But again, as an initial presentation in the ER, no pediatric surgeon would think this child had appendicitis based on an ultrasound showing ascites — that does not mean that after 24 hours of the child worsening that perhaps more aggressive measures should have been considered.