Tu1575 Conservative Treatment and Interval Appendectomy for Acute Appendicitis

Introduction: Appendicular mass is a common complication of acute appendicitis. The traditional treatment of this is conservative followed by delayed appendectomy. But now with advancement in all the fields of medicine early surgical exploration of the appendicular mass can be done with satisfactory results. Aims and objectives: A comparison of conservative treatment versus early surgical exploration of appendicular mass. Study Design: Experimental study. Material and Method: Two years study from December 2003 to November 2005 at district headquarters hospital Khanewal. Total 60 patients, both males and females between 12 to 65 years of age with symptoms and signs consistent with appendicular mass were included. They were randomly divided into group I (Early exploration) and group II (Conservative treatment) each containing 30 patients. A comparison of outcome between two groups was done statistically by applying studentChi-square test. Results: There was a peak incidence of acute appendicitis in Second and third decades of life. Male to female ratio was 2:1. More than 90% of patients had history of shifting of abdominal pain. 100% of the patients had inflamed appendix to variable extent on exploration. The complications in the form of adhesive intestinal obstruction; failure of treatment; lost follow up; misdiagnosis and re admissionwere less in group I. There was a significant less duration of hospital stay in group I as compared to Group II. The observations and outcome in this study are almost comparable and correspond with other studies done in this regard. Conclusion: Early surgical exploration of appendicular mass is safe and cost effective.

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Antibiotics in acute appendicitis. When and how? A general review

Journal of Surgical Sciences ◽

10.33695/jss.v6i1.258 ◽

2019 ◽

Vol 6 (1) ◽

pp. 30-33

Author(s):

L. Alecu ◽

C. Niţipir ◽

Iulian Slavu ◽

V. Braga ◽

D. Mihăilă ◽

...

Keyword(s):

Acute Appendicitis ◽

Antibiotic Treatment ◽

Complication Rate ◽

Acquired Resistance ◽

Perforated Appendicitis ◽

Interval Appendectomy ◽

Bacterial Proliferation ◽

Long Period ◽

Clinical Surveillance ◽

Relapse Rates

Introduction: An increasing interest exits towards the use of antibiotics in the treatment of uncomplicated acute appendicitis.Discussion: For a long period of time, surgery was the only treatment for acute appendicitis. Due to recent research in the etiology of acute appendicitis which seems to be driven by intraluminal bacterial proliferation, new data suggests that for non-perforated appendicitis confirmed with the help of CT, antibiotics may play a central role in the treatment. As relapse rates amount in some cases to only 5% after antibiotic treament, a discussion is required regarding the risks of interval appendectomy and its use. The debate regarding the optimal antibiotic course is on-going as some surgeons advocate for amoxicillin/clavulanic while others, due to acquired resistance recommend Ertapenem.Conclusion: Selective antibiotic treatment for selected forms of acute appendicitis, uncomplicated without perforation is safe and has a relatively low complication rate. However, certain mentions must be made: surgery must not be delayed if failure of antibiotics exists as it can lead to higher rates of peritonitis. Close clinical surveillance is of utmost importance

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Ultrasonographic Findings after Conservative Treatment of Acute Appendicitis and Open Appendicectomy

Acta Radiologica ◽

10.1177/028418519503600213 ◽

1995 ◽

Vol 36 (2) ◽

pp. 173-177 ◽

Cited By ~ 7

Author(s):

S. Eriksson ◽

Å. Tisell ◽

L. Granström

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Antibiotic Treatment ◽

Randomized Study ◽

Open Appendicectomy ◽

Recurrent Appendicitis ◽

Us Findings

In a randomized study we investigated the effects of antibiotics as the only treatment in acute appendicitis. Forty patients were examined, 19 after antibiotic treatment (one operated due to perforation) and 21 after surgery. All patients were examined prior to randomization, after 10 days and after 30 days. Of the positive ultrasonographic (US) findings, 18 (86%) of the 21 operated patients had histologically proven acute appendicitis. At the 10th day, 9 patients had a seroma under the scar, which had disappeared a month after surgery in all patients. In the 19 patients conservatively treated with antibiotics, the appendix could be visualized in 8 symptom-free cases on the 10th day. In 5 of the 8 patients the appendix was still visualized after 1 month. Three of these 5 had recurrent appendicitis within a year. It is concluded that US can be used not only in diagnosing acute appendicitis, but also in the evaluation of treatments such as antibiotics.

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Acute appendicitis with a neuroendocrine tumor G1 (carcinoid): pitfalls of conservative treatment

Clinical Journal of Gastroenterology ◽

10.1007/s12328-016-0660-9 ◽

2016 ◽

Vol 9 (4) ◽

pp. 203-207 ◽

Cited By ~ 2

Author(s):

Hiroyuki A. Watanabe ◽

Taketoshi Fujimoto ◽

Yo Kato ◽

Mayumi Sasaki ◽

Toshikazu Ikusue

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Neuroendocrine Tumor

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MODERN APPROACHES TO CONSERVATIVE TREATMENT OF ACUTE APPENDICITIS IN CHILDREN

SCIENTIFIC ASPIRATIONS ◽

10.31882/2311-4711.2018.24.18 ◽

2018 ◽

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis

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1565 In Covid-19 Pandemic, Following the Updated Royal College of Surgeons of England Guidelines in Management of Acute Appendicitis; A General District Hospital Audit

British Journal of Surgery ◽

10.1093/bjs/znab259.176 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Dorra ◽

M Abdellatif ◽

W Fahmy ◽

Y Salama

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Royal College ◽

Conservative Management ◽

District Hospital ◽

Admission Rate ◽

Operative Management ◽

Operative Intervention ◽

Coding System ◽

Conservative Group

Abstract Aim The Aim of the study is assessment of the compliance with the updated Royal College of Surgeons of England (RCS) guidelines in management of acute appendicitis in a general district hospital during COVID-19 pandemic. Conservative treatment of acute appendicitis is encouraged unless unresponsiveness to treatment or complications ensues. Method Collection of retrospective data using hospital coding system was done from 63 patients medical records who were diagnosed with acute appendicitis from April 2020 to June 2020. Results The collected data analysis showed adherence to conservative treatment in 16 out of 63 (16/63) patients (25.4%). It succeeded in 10/16 patients (63 %). 6/16 patients were switched to operative intervention (37 %). There were no complications in patients who needed operative intervention after failure of conservative management. Operative management was primarily chosen in 47/63 patients (74.6 %). Re-admissions were 3/16 patients (18.75 %) in conservative group in comparison to 1/47 patient (2.12 %) in primarily operative group. Conclusions The work showed a promising rate of success of conservative treatment. However, there is a low level of compliance with RCS guidelines in management of acute appendicitis during COVID-19 pandemic. The study showed increased re-admission rate for conservative management versus primarily operative management pathways. No complications were detected in cases who needed operative intervention after failure of conservative management. Re-auditing is to follow. The study recommends national comparison of data as it might be worthwhile considering primary management of acute appendicitis.

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Clinical Outcomes for Interval Appendectomy in the Treatment of Acute Appendicitis With an Appendiceal Abscess or Mass

The American Journal of Gastroenterology ◽

10.14309/00000434-201510001-01273 ◽

2015 ◽

Vol 110 ◽

pp. S560

Author(s):

Hiromitsu Kinoshita ◽

Masato Kondo ◽

Shoichi Kitano ◽

Yukiko Kumata ◽

Ryosuke Kita ◽

...

Keyword(s):

Acute Appendicitis ◽

Clinical Outcomes ◽

Interval Appendectomy ◽

Appendiceal Abscess

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Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety

European Journal of Pediatrics ◽

10.1007/s00431-017-2867-2 ◽

2017 ◽

Vol 176 (4) ◽

pp. 521-527 ◽

Cited By ~ 10

Author(s):

Zvi Steiner ◽

Genady Buklan ◽

Rodica Stackievicz ◽

Michael Gutermacher ◽

Ita Litmanovitz ◽

...

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Uncomplicated Acute Appendicitis

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A clinical study on conservative management of acute appendicitis in a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20211296 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1190

Author(s):

Bhanu Bharath Naik

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Clinical Symptoms ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Alvarado Score ◽

Uncomplicated Appendicitis ◽

Laboratory Investigations ◽

Modified Alvarado Score ◽

Uncomplicated Acute Appendicitis

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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