Manejo de la apendicitis aguda en pediatría: Artículo de revisión
Management of acute appendicitis in pediatrics: Review article
DOI:
https://doi.org/10.56712/latam.v6i3.4142Palabras clave:
apendicitis aguda, pediatría, ecografía, laparoscopíaResumen
La apendicitis aguda es la principal causa de cirugía abdominal en niños, con una incidencia creciente atribuida a mejores diagnósticos y cambios en la dieta. El enfoque actual combina escalas clínicas, ecografía como método inicial y, en algunos casos, tratamiento no quirúrgico con antibióticos. La apendicectomía laparoscópica sigue siendo el estándar, pero nuevas estrategias como ERAS han mejorado la recuperación postoperatoria. El objetivo principal es actualizar conocimientos sobre el tratamiento de apendicitis aguda en pediatría. En mayo del 2025, se realizó un artículo de revisión acerca del tratamiento de apendicitis aguda, este está basado en estudios de los últimos 5 años encontrados en base de datos como PubMed, MEDLINE, EMBASE y Google Académico. Se identificaron 22 estudios que cumplen con los criterios de inclusión e incluyen definición, clasificación, escalas de puntuación, diagnósticos, tratamiento farmacológico, tratamiento quirúrgico y complicaciones del tema descrito. La apendicitis aguda es la principal causa de cirugía urgente en niños, con diagnóstico desafiante por síntomas variables. Se recomienda un enfoque combinado: escalas clínicas, ecografía inicial y apoyo de imágenes avanzadas. Aunque la apendicectomía laparoscópica sigue siendo el estándar, el tratamiento no quirúrgico es viable en casos seleccionados, y se espera que nuevos biomarcadores mejoren el abordaje futuro.
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AlRamahi, R. W., Woerner, A., Rizvi, H., & Monroe, E. J. (2025). Complicated appendicitis in the pediatric patient: Interventional perspectives. Clinical Imaging, 118, 110371. https://doi.org/10.1016/j.clinimag.2024.110371
Al-Taher, R., Alshahwan, H., Abdelhadi, S., Abeeleh, F. A., Rashdan, M., Amarin, M., et al. (2023). Enhanced recovery concepts in paediatric patients who underwent appendectomy: A retrospective cohort study at a tertiary university hospital. Journal of International Medical Research, 51(2), 3000605231158524. https://doi.org/10.1177/03000605231158524
Appendicitis/Appendectomy. (2024). Texas Children’s Hospital Evidence-Based Outcomes Center. https://www.texaschildrens.org/sites/tc/files/uploads/documents/outcomes/2024%20standards/Appendicitis%20Guideline%20FINAL.pdf?utm_source=chatgpt.com
Ata, N. A., Trout, A. T., Dillman, J. R., Tkach, J. A., & Ayyala, R. S. (2024). Technical and diagnostic performance of rapid MRI for evaluation of appendicitis in a pediatric emergency department. Academic Radiology, 31(3), 1102–1110. https://doi.org/10.1016/j.acra.2023.09.040
Brucchi, F., Filisetti, C., Luconi, E., Fugazzola, P., Cattaneo, D., Ansaloni, L., et al. (2025). Non-operative management of uncomplicated appendicitis in children, why not? A meta-analysis of randomized controlled trials. World Journal of Emergency Surgery, 20(1), 25. https://doi.org/10.1186/s13017-025-00584-9
Cotton, D. M., Vinson, D. R., Vazquez-Benitez, G., Warton, M. E., Reed, M. E., Chettipally, U. K., et al. (2019). Validation of the pediatric Appendicitis Risk Calculator (pARC) in a community emergency department setting. Annals of Emergency Medicine, 74(4), 471–480. https://doi.org/10.1016/j.annemergmed.2019.04.023
Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., et al. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery, 15, 27. https://doi.org/10.1186/s13017-020-00306-3
He, R., Lai, J., Jiang, O., & Li, J. (2025). The incidence and temporal trend of appendicitis in children: An analysis from the Global Burden of Disease Study 2021. Journal of Gastrointestinal Surgery, 29(2), 101935. https://doi.org/10.1016/j.gassur.2024.101935
Hellmann, Z. J., Rehman, S., Hornick, M., & Solomon, D. G. (2024). Unplanned readmission rate before interval appendectomy after nonoperative management of complicated appendicitis. Journal of the American College of Surgeons. https://doi.org/10.1097/XCS.0000000000001255
Hernandez, M. C., Polites, S. F., Aho, J. M., Haddad, N. N., Kong, V. Y., Saleem, H., et al. (2018). Measuring anatomic severity in pediatric appendicitis: Validation of the American Association for the Surgery of Trauma appendicitis severity grade. The Journal of Pediatrics, 192, 229–233. https://doi.org/10.1016/j.jpeds.2017.09.017
Jumah, S., & Wester, T. (2022). Non-operative management of acute appendicitis in children. Pediatric Surgery International, 39, 11. https://doi.org/10.1007/s00383-022-05284-y
Ju, J.-J., Zhang, T., Cheng, Y., Zhou, Y.-L., Qi, S.-Q., Zhang, Z.-Q., et al. (2024). Risk factors for acute complicated appendicitis in children aged three years and younger. BMC Pediatrics, 24, 484. https://doi.org/10.1186/s12887-024-04959-w
Neogi, S., Banerjee, A., Panda, S. S., Ratan, S. K., & Narang, R. (2022). Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis. Journal of Pediatric Surgery, 57(3), 394–405. https://doi.org/10.1016/j.jpedsurg.2021.07.005
Pediatric appendicitis US: Practical considerations. (s.f.). Applied Radiology. https://appliedradiology.com/articles/pediatric-appendicitis-us-practical-considerations?utm_source=chatgpt.com
Rolle, U., Bechstein, W. O., Fahlenbrach, C., Heller, G., Meyer, H.-J., Schuler, E., et al. (2024). The outcome of laparoscopic versus open appendectomy in childhood. Deutsches Ärzteblatt International, 121(2), 39–44. https://doi.org/10.3238/arztebl.m2023.0234
Scaife, J. H., Iantorno, S. E., & Bucher, B. T. (2024). Rates of concurrent computed tomography imaging following ultrasound for pediatric patients with appendicitis. Journal of Surgical Research, 302, 134–143. https://doi.org/10.1016/j.jss.2024.06.048
St Peter, S. D., Noel-MacDonnell, J. R., Hall, N. J., Eaton, S., Suominen, J. S., Wester, T., et al. (2025). Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: An open-label, international, multicentre, randomised, non-inferiority trial. The Lancet, 405(10474), 233–240. https://doi.org/10.1016/S0140-6736(24)02420-6
Steiner, Z., Gilad, Y., Gutermacher, M., Stackievicz, R., Bauer-Rusek, S., & Arnon, S. (2022). Acute appendicitis in children: Reexamining indications for conservative treatment - A large prospective analysis. Journal of Pediatric Surgery, 57, 373–379. https://doi.org/10.1016/j.jpedsurg.2021.12.012
Talan, D. A., & Di Saverio, S. (2021). Treatment of acute uncomplicated appendicitis. The New England Journal of Medicine, 385, 1116–1123. https://doi.org/10.1056/NEJMcp2107675
Tan, A. P. P., Yap, T.-L., Cheong, Y. L., Rai, R., Choo, C., Ong, C., et al. (2022). Conservative antibiotic treatment of pediatric acute uncomplicated appendicitis during the COVID-19 pandemic: A prospective comparative cohort study. Pediatric Surgery International, 39, 60. https://doi.org/10.1007/s00383-022-05344-3
Yoon, H. M., Suh, C. H., Cho, Y. A., Kim, J. R., Lee, J. S., Jung, A. Y., et al. (2018). The diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients: A systematic review and diagnostic meta-analysis. European Radiology, 28(6), 2537–2548. https://doi.org/10.1007/s00330-017-5231-z
Zouari, M., Hbaieb, M., Issaoui, A., Krichen, E., Safi, F., Dhaou, M. B., et al. (2024). Ultrasound assessment in children with suspected appendicitis: Time to revise diagnostic criteria: A prospective cohort study. Surgical Infections, 25(4), 300–306. https://doi.org/10.1089/sur.2023.370
