Appendicitis in cystic fibrosis: can morbidity be reduced?

Abstract

The management of appendicitis in cystic fibrosis (CF) has been controversial, and most series report a mortality of over 30%. Difficulties are distinguishing appendicitis from meconium ileus equivalent (MIE) often cause diagnostic delay and advanced disease by the time surgery is undertaken. We report a series of 9 patients with appendicitis proven on histology in whom there was no mortality and minimal morbidity. Factors likely to reduce morbidity and mortality in appendicitis in children with CF include early diagnosis; preoperative intravenous antibiotics effective against both bowel and chest organisms; early appendicectomy; avoidance of right hemicolectomy, or drainage alone; thorough peritoneal irrigation with warm antibiotic saline solution; and continuous postoperative narcotic analgesia to allow early mobilisation and effective chest physiotherapy. Accurate early diagnosis is facilitated if these children are treated by respiratory paediatricians and paediatric surgeons in a centre familiar with the management of cystic fibrosis. Delay in appendicectomy worsens the underlying respiratory disease.