Appendicitis

[size=20px]A 12-year-old boy presents to the emergency department with right lower quadrant pain. His clinical history and imaging are consistent with perforated appendicitis, confirmed intraoperatively. Based on the IMPPACT trial, which antibiotic regimen is associated with a decreased risk of intra-abdominal abscess formation in patients with perforated appendicitis? A ampicillin, gentamicin, and clindamycin B cefotaxime and metronidazole C ceftriaxone and metronidazole D piperacillin-tazobactam E ciprofloxacin and metronidazole[/size]

A 10-year old girl undergoes an appendectomy that was converted from a laparoscopic to an open procedure due to significant periappendiceal inflammation. She was treated with antibiotics for five days and discharged. Two weeks later she returns with fever and right flank pain. A computerized tomography (CT) scan reveals right hydronephrosis and a dilated proximal ureter. Delayed images show no contrast in the ureter beyond the pelvic brim. There is a moderate fluid collection with some surrounding inflammation near the pelvic brim. Aspiration of the collection reveals urine. She is started on intravenous fluids and broad spectrum antibiotics. The next best step in managem…

[size=20px]A six-year old girl undergoes an uncomplicated laparoscopic appendectomy for acute nonperforated appendicitis. She receives a single intravenous dose of cefoxitin twenty five minutes prior to the incision. Which of the following postoperative antibiotic regimens is most appropriate for nonperforated appendicitis? A intravenous cefoxitin for five days B oral ampicillin/sulbactam until discharge C intravenous cefoxitin for one day D no further antibiotics E oral ampicillin/sulbactam for five days[/size]

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[size=20px]A 10-year-old girl presents with nausea, vomiting, and vague abdominal pain. She has mild RLQ tenderness and all labs (including WBC count) are normal. Ultrasound is unable to visualize the appendix and is otherwise normal. What is the best next step in management? A IV antibiotics and laparoscopic appendectomy B Non-operative management with IV antibiotics only C CT scan with PO and IV contrast D MRI without contrast E Observation[/size]

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[size=20px]An ill-appearing ten-year old male presents with a five day history of abdominal pain that now localizes to his right lower quadrant. A computerized tomography scan demonstrates a dilated appendix with periappendiceal inflammation and free peritoneal fluid. The optimal management of this patient with presumed perforated appendicitis is parenteral broad spectrum antibiotics A alone. B with subsequent interval appendectomy. C with drainage of the peritoneal fluid by interventional radiology. D with delayed appendectomy if his condition deteriorates. E with immediate appendectomy.[/size]

[size=20px]After completing a course of oral antibiotics following laparoscopic appendectomy for perforated appendicitis, an eight-year old returns with fever and abdominal pain. He is well appearing and tolerating a regular diet. His white blood cell count is 20,000 cells/µL. An ultrasound reveals a three centimeter pelvic abscess surrounded by bowel and no fecalith. The most appropriate initial treatment for this patient with an abscess following appendectomy is A second course of oral antibiotics. B broad spectrum parenteral antibiotics. C image guided drainage. D laparoscopic drainage. E open drainage.[/size]

[size=20px]An abdominal computerized tomography (CT) scan is obtained in a six year old boy after a motor vehicle crash. The scan is normal except for an incidental appendicolith with no radiographic signs of acute appendicitis. The child has no symptoms to suggest appendicitis. The most appropriate management of this patient with an incidentally discovered appendicolith is A immediate appendectomy. B elective appendectomy. C admission for observation. D follow-up CT scan. E instructions to return if symptomatic.[/size]