Journal of Gastrointestinal Surgery

, Volume 13, Issue 5, pp 966–970 | Cite as

RETRACTED ARTICLE: Conservative Management of Acute Appendicitis

Original Article

Abstract

Background

The acute appendicitis is the most common abdominal emergency, and the primary treatment has been appendicectomy. Antibiotics are started preoperatively and continued postoperatively as needed.

Methods

This prospective study was carried out at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India to determine the role of antibiotics as the only treatment in acute appendicitis and the analgesic consumption needed. Total of 80 patients were included in the study with a duration of abdominal pain less than 72 h. Out of 80 patients, 40 patients received antibiotics intravenously for 2 days followed by oral treatment for 7 days, while another 40 patients considered as controls were randomized to surgery.

Results

Patients managed conservatively were discharged within 3 days except for two—patients who required surgery after 12 and 24 h, respectively, because of peritonitis due to perforated appendicitis. Four patients were readmitted within 1 year as a result of recurrent appendicitis and had to undergo surgery when appendicitis was confirmed. The diagnostic accuracy within the operated group was 90%. Two patients had perforated appendicitis at operation.

Conclusion

Our conclusion is that antibiotic treatment in the patients with acute appendicitis is quite effective, and these patients may not need surgery. The patients managed conservatively with antibiotics alone experience less pain and require less analgesia but have high recurrent rate.

Keywords

Acute appendicitis Peritonitis Antibiotics Ultrasonography 

References

  1. 1.
    McBurney C. Experiences with early operative interference in cases of disease of the vermiform appendix. N Y Med J 1889;50:1676–1684.Google Scholar
  2. 2.
    Coldrey E. Five years of conservative treatment of acute appendicitis. J Int Coll Surg 1959;32:255–261.Google Scholar
  3. 3.
    Anonymous. Combined traditional Chinese and western medicine in acute appendicitis. Chin Med J 1977;3:266–269.Google Scholar
  4. 4.
    Surana R, Quinn F, Puri P. Is it necessary to perform appendectomy in the middle of the night in children. BMJ 1993;306:1168.PubMedCrossRefGoogle Scholar
  5. 5.
    Ambjommson E. Management of appendiceal abscess. Curr Surg 1984;41:4–9.Google Scholar
  6. 6.
    Bagi P, Oueholm S. Non-operative management of the ultrasonically evaluated appendiceal mass. Surgery. 1987;101:602–605.PubMedGoogle Scholar
  7. 7.
    Engkvist O. Appendectomy a froid: a superfluous routine operation? Acta Chir Scand 1971;137:797–800.PubMedGoogle Scholar
  8. 8.
    McPherson AG, Kinmoth JB. Acute appendicitis and the appendix mass. Br J Surg. 1945;32:365–70. doi:10.1002/bjs.18003212705.CrossRefGoogle Scholar
  9. 9.
    Thomas DR. Conservative management of the appendix mass. Surgery 1973;73:677–80.PubMedGoogle Scholar
  10. 10.
    EACS. Acute appendicitis—Operative versus conservative management: EACS guidelines for endoscopic surgery. Heidelberg: Springer, 2006, pp 387–389.Google Scholar
  11. 11.
    Mosegaard A, Nielsen OS. Interval appendectomy: A retrospective study. Acta Chir Scand 1979;145:109–11.PubMedGoogle Scholar
  12. 12.
    Adams ML. The medical management of acute appendicitis in a non-surgical environment: a retrospective case review. Mil Med. 1990;155:345–347.PubMedGoogle Scholar
  13. 13.
    Gurin NN, Slobodchuk IUS, Gavrilov IUF. The efficacy of the conservative treatment of patients with acute appendicitis on board ships at sea. Vestn Khir 1992;148:144–150.PubMedGoogle Scholar
  14. 14.
    Eriksson S, Granstrom L. Randomized controlled trial of appendectomy versus antibiotic therapy for acute appendicitus. Br J Surg. 1995;82:166–169. doi:10.1002/bjs.1800820207.PubMedCrossRefGoogle Scholar
  15. 15.
    Malik AA, Wani NA. Continuing diagnostic challenge of acute appendicitis-evaluation through modified Alvarado score. Aust N Z J Surg 1998;68:504–505. doi:10.1111/j.1445-2197.1998.tb04811.x.PubMedCrossRefGoogle Scholar
  16. 16.
    Eriksson S, Granstrom L, Bark S. Laboratory tests in patients with suspected acute appendicitis. Acta Chir Scand 1989;155:11–20.Google Scholar
  17. 17.
    Granstrom L, Erikson S, Tisell A. Ultrasonography as a tool in the diagnosis of acute appendicitis: A prospective study. Surg Res Commun 1992;11:309–314.Google Scholar
  18. 18.
    Puylaert JBCM. Acute appendicitis US evaluation using graded compression. Radiology 1986;158:355–360.PubMedGoogle Scholar
  19. 19.
    Huskisson EC. Measurement of pain. Lancet 1974;2(7889):1127–1131.PubMedCrossRefGoogle Scholar
  20. 20.
    Horton MD, Counter SF, Florence MG, Hart MJ. A prospective trail of computed tomography and ultra sonagraphy for diagnosing appendicitis in the atypical patients. Am J Surg 2001;182(3):305–306. doi:10.1016/S0002-9610(01)00645-6.CrossRefGoogle Scholar
  21. 21.
    Oeutsch AA, Shani N, Reiss R. Are some appendicectomies unnecessary? An analysis of 319 white appendices. J R Coll Surg Edinb 1983;28:35–40.Google Scholar
  22. 22.
    Pieper R, Kager L, Nasman P. Acute appendicitis: a clinical study of 1018 cases of emergency appendectomy. Acta Chir Scand 1982;148:51–62.PubMedGoogle Scholar
  23. 23.
    Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis. A prospective study. Ann R Coll Surg Engl. 1994;76:418–419.PubMedGoogle Scholar
  24. 24.
    Arnbjornsson E. Small intestinal obstruction after appendectomy: an avoidable complication? Curr Surg 1984;41:354–357.PubMedGoogle Scholar
  25. 25.
    Raf LE. Causes of abdominal adhesions in cases of intestinal obstruction. Acta Chir Scand 1969;135:73–76.PubMedGoogle Scholar
  26. 26.
    Grosfeld JL, Weinberger M, Clatworthy HW Jr. Vascularized appendical transplants in biliary and urinary tract replacement. J Pediatr Surg 1971;6:630–638. doi:10.1016/0022-3468(71)90389-7.PubMedCrossRefGoogle Scholar
  27. 27.
    WeinJberg RW. Appendix ureteroplasty. Br J Urol 1976;48:234.Google Scholar
  28. 28.
    Eriksson S, Granstrom L, Tisell A. Ultrasonography in suspected acute appendicitis. Is it difficult to learn. Br J Surg 1993;80(suppl):4. doi:10.1002/bjs.1800800104.Google Scholar
  29. 29.
    Singh JK et al. Imaging of acute abdomen and pelvis: Acute appendicitis and beyond. Radiographies 2007;27:1419–1431. doi:10.1148/rg.275065021.CrossRefGoogle Scholar
  30. 30.
    Athey PA, Hacken JB, Estrada R. Sonographic appearance of mucocele of the appendix. J Clin Ultrasound. 1984;12:333–337. doi:10.1002/jcu.1870120604.PubMedCrossRefGoogle Scholar
  31. 31.
    Simpson J, Scholefield J. Acute appendicitis. The Foundation Years 2006;2(2):72–75.CrossRefGoogle Scholar
  32. 32.
    Roggo A, Wood WC, Ottinger LW. Carcinoid tumours of the appendix. Ann Surg 1993;217:385–90. doi:10.1097/00000658-199304000-00010.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  1. 1.Department of SurgerySher-i-Kashmir Institute of Medical SciencesSrinagarIndia

Personalised recommendations