Perforated appendicitis: past and future controversies.

Although mortality rates for pediatric appendicitis have been reduced to near zero with the development of safe surgical procedures and routine perioperative antibiotic therapy, the incidence of perforated appendicitis in children has remained at a comparatively high level. This article reviews the recent literature on perforated pediatric appendicitis, including a discussion of some of the controversies concerning management of the ruptured appendix. In addition, the future of both the evaluation and treatment of this disease, including laparoscopy, the possibilities for outpatient antibiotic therapy, and the worrisome potential for a change in referral patterns as children with this disease are increasingly enrolled in managed care plans, are considered.