Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety

Background: Acute appendicitis is the most common clinical entity which is treated surgically by appendectomy. In recent years acute uncomplicated appendicitis can also be managed non surgically with antibiotic therapy. Aim and Objective was to assess the outcome of conservative treatment in the management of acute appendicitis.Methods: All patients who were diagnosed as acute appendicitis radiologically were enrolled into the study considering inclusion and exclusion criteria. Modified Alvarado score (MAS) was calculated based on clinical symptoms, signs and laboratory investigations. Injection ceftriaxone and injection metronidazole was given for 48-72 hours. Patients who responded for i.v. antibiotics were switched to tablet ciprofloxacin and tablet metronidazole for 7 days and followed for 6 months. Patients who didn’t respond to conservative treatment or had recurrence were classified as treatment failure/recurrence.Results: Totally 100 patients were enrolled in the study, 43 males and 57 females with a ratio of 1:1.32. Majority were in age group of 21-30. Ultrasound was performed in 91 patients, CT scan in 9 patients. 28 patients had MAS between 4-6 and 72 had between 7-9. 82 patients were successfully managed conservatively. 12 patients had failure of conservative treatment and 6 patients had recurrence.Conclusions: Success rate of conservative treatment in patients with MAS 4-6 was more than those with MAS 7-9 in this study. Complicated acute appendicitis should be managed surgically and uncomplicated acute appendicitis can be managed by conservative treatment provided they are strictly followed every month for 6 months to detect recurrences.

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Evaluation of conservative management in uncomplicated acute appendicitis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213179 ◽

2021 ◽

Author(s):

Vignesh M. ◽

Rajkumar Chejara ◽

S. V Arya ◽

Ankit Bhatia ◽

Rohit Chaudhary ◽

...

Keyword(s):

Standard Deviation ◽

Conservative Treatment ◽

Acute Appendicitis ◽

Conservative Management ◽

Significant Proportion ◽

Alvarado Score ◽

Intravenous Antibiotics ◽

Uncomplicated Appendicitis ◽

Uncomplicated Acute Appendicitis

Background: Appendectomy has been the treatment for acute appendicitis for years based on the understanding that acute appendicitis always leads to perforation and peritonitis. However, there is growing evidence that a significant proportion of patients can be successfully managed with conservative treatment without developing gangrene or perforation. Conservative treatment avoids discomfort, surgery-related morbidities and minimizes treatment cost.Methods: 60 patients taken up for conservative management were evaluated and followed up for 6 months. Study patients received intravenous antibiotics for 2 days. Repeated clinical and TLC monitoring were done. In patients whose clinical condition did not improve, appendectomy was performed. Follow-up at 10 days, 30 days, 3 months and 6 months were carried out to assess recurrence in conservatively managed patients.Results: In this study, the mean age was 25.65 years with a standard deviation of ±8.96 years. The incidence of uncomplicated appendicitis was 63.3% in males and 36.7% in females. Mean Alvarado score was 7.75 with a standard deviation of ±1.20. Failure of conservative management (conversion to appendectomy) was observed in 11.7% of patients and 4 patients (6.6%) had recurrence within 6 months. The overall treatment efficacy was 81.7%.Conclusions: In many cases, first attack of uncomplicated acute appendicitis can be treated successfully by conservative management. Treatment failure on primary admission as well as short-term recurrence up to six months after conservative treatment is low and acceptable. Incidence of complications like perforation and abscess formation are also statistically low.

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Correction to: Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score–matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial)

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03862-5 ◽

2021 ◽

Vol 36 (3) ◽

pp. 599-599

Author(s):

Mauro Podda ◽

◽

Gaetano Poillucci ◽

Daniela Pacella ◽

Lorenzo Mortola ◽

...

Keyword(s):

Propensity Score ◽

Conservative Treatment ◽

Acute Appendicitis ◽

Multicenter Trial ◽

Patient Centered ◽

Uncomplicated Acute Appendicitis ◽

Prospective Multicenter Trial

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Appendectomy versus conservative treatment with antibiotics for patients with uncomplicated acute appendicitis: a propensity score–matched analysis of patient-centered outcomes (the ACTUAA prospective multicenter trial)

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03843-8 ◽

2021 ◽

Vol 36 (3) ◽

pp. 589-598

Author(s):

Mauro Podda ◽

◽

Gaetano Poillucci ◽

Daniela Pacella ◽

Lorenzo Mortola ◽

...

Keyword(s):

Propensity Score ◽

Conservative Treatment ◽

Acute Appendicitis ◽

Multicenter Trial ◽

Patient Centered ◽

Uncomplicated Acute Appendicitis ◽

Prospective Multicenter Trial

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Acute Appendicitis: After Correct Diagnosis Conservative Treatment or Surgery?

10.5772/intechopen.95870 ◽

2021 ◽

Author(s):

Anestis Charalampopoulos ◽

Nikolaos Koliakos ◽

George Bagias ◽

Georgia Bompetsi ◽

Nikolaos Zavras ◽

...

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Correct Diagnosis ◽

Daily Practice ◽

Imaging Data ◽

Review Of The Literature ◽

Generalized Peritonitis ◽

Appropriate Treatment ◽

Correct Estimation ◽

Uncomplicated Acute Appendicitis

Acute appendicitis is the most common surgical disease presented in ED. Ongoing evidence in the literature, in the last 20 years, shows a lot of benefits in favor of conservative treatment. Despite that conservative treatment does not gain the correct position at the daily practice up to day. A large number of parameters related to acute appendicitis, present diversity in their appearance, so the final estimation of the disease may by unclear and the decision for treatment may be incorrect. We analyze these parameters, aiming to clarify their role in correct diagnosis and decision making on appropriate treatment. In the present study a review of the literature is performed, regarding the etiology, pathology, clinical presentation, laboratory, and imaging data of acute appendicitis. The collection and correct estimation of these parameters, is the key for the correct diagnosis of acute appendicitis. Complicated or uncomplicated cases should be diagnosed preoperatively. The next step is the appropriate treatment, conservative or by surgery. At the present time, excluding generalized peritonitis and sepsis, the majority of patients with uncomplicated acute appendicitis and selected complicated cases can by treated successfully by conservative treatment. The majority of patients do not benefit from appendectomy.

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Study of conservative treatment in uncomplicated acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20171152 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1409 ◽

Cited By ~ 1

Author(s):

B. S. Gedam ◽

Ajit Gujela ◽

Prasad Y. Bansod ◽

Murtaza Akhtar

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Treatment Failure ◽

Tertiary Care ◽

Operative Management ◽

Care Hospital ◽

Alvarado Score ◽

Modified Alvarado Score ◽

Uncomplicated Acute Appendicitis ◽

Non Operative Management

Background: Management of acute appendicitis with antibiotics only, without surgery is currently evaluated. Non-operative management of uncomplicated acute diverticulitis and salpingitis has been well established but the non-operative management of acute appendicitis remains controversial. Growing evidence indicates that patients with acute uncomplicated appendicitis can be treated safely with an antibiotics- first approach.Methods: A tertiary care hospital based longitudinal study with duration of 26 month. Patients with clinical and radiological feature of acute appendicitis presenting within 48 hours of initiation of abdominal pain with Modified Alvarado Score ≥5 included. Various demographic, clinico-pathological, radiological factors were studied.Results: 71 patients evaluated, mean age of 30.45±9.71 years. Tenderness in RIF was the commonest finding followed by Fever and rebound tenderness. Leucocytosis seen in 74.65% Modified Alvarado score of 5-6 was present in 18.32% whereas 7-9 was present in 81.68% patients. USG was suggestive of appendicitis in 84.50% patients. Conservative treatment was successful in 74.65% patients with no treatment failure. 25.35% patients, conservative treatment failed. Overall recurrence was seen in 13.11% cases that were successfully managed during primary admission.Conclusions: Majority of cases of first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment requires monitoring and repeated re-evaluation to identify failure which needs to be treated promptly by surgery. Treatment failure on primary admission as well as the short- term recurrence after conservative treatment is low and acceptable. The outcome of conservative treatment does not depend on Modified Alvarado Score.

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Conservative treatment for uncomplicated acute appendicitis in adults

Emergency Medicine and Health Care ◽

10.7243/2052-6229-1-2 ◽

2013 ◽

Vol 1 (1) ◽

pp. 2

Author(s):

Michele Pisano ◽

Federico Coccolini ◽

Elia Poiasina ◽

Paolo Bertoli ◽

Michela Giulii Capponi ◽

...

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Uncomplicated Acute Appendicitis

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Spontaneous recovery from uncomplicated acute appendicitis

Pediatria i Medycyna Rodzinna ◽

10.15557/pimr.2020.0052 ◽

2020 ◽

Vol 16 (3) ◽

pp. 285-288

Author(s):

Szymon Tobor ◽

◽

Grzegorz Kudela ◽

Klaudia Korecka ◽

Tomasz Koszutski ◽

...

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Acute Appendicitis ◽

Watchful Waiting ◽

Clinical Laboratory ◽

Clinical Signs ◽

Laboratory Diagnosis ◽

Clinical Criteria ◽

Suspected Appendicitis ◽

Uncomplicated Acute Appendicitis

Background: Historically, acute appendicitis requires surgical treatment. In recent years, there has been an increased interest in treating uncomplicated cases in a conservative way. The development in radiological and laboratory diagnosis has allowed for better possibilities of identification and watchful waiting of simple appendicitis. Objectives: The aim of the study was a retrospective evaluation of the efficacy of conservative treatment of uncomplicated acute appendicitis in children diagnosed based on clinical, laboratory and sonographic signs. Materials and methods: The diagnosis of uncomplicated acute appendicitis was based on the clinical signs, laboratory tests and ultrasound findings. Two clinical criteria, one laboratory criterion and two sonographic criteria, were assumed as a clear diagnosis of appendicitis. the retrospective assessment was conducted among 382 children who were hospitalised for suspected appendicitis. In those we identified a group of 66 children who met the criteria of acute appendicitis. The efficacy of conservative treatment in patients who met the criteria mentioned above was evaluated. Results: Within the period of at least one year, 89.4% of patients (59/66) were not re-hospitalised for recurrent symptoms. Eventually, 92.4% of patients (61/66) included in the study did not require surgical treatment. Conclusion: Uncomplicated acute appendicitis should be initially treated conservatively with watchful waiting. The vast majority of uncomplicated appendicitis cases can resolve spontaneously.

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