Vol 62, No 4 (2010)
MARITIME MEDICINE Review articles
Published online: 2011-02-24
Conservative treatment of acute appendicitis: an overview
IMH 2010;62(4):265-272.
Abstract
Background. Although the standard treatment for appendicitis (since 1883) is an appendectomy, this is not always possible in a maritime or military setting. To avoid relying on improvisation in such situations this study examines the evidence for conservative management of appendicitis.
Material and methods. PubMed was searched for studies on conservative treatment of appendicitis. Both prospective and retrospective studies with a well-defined description of the protocol were included.
Results. Finally, 5 publications (a total of 342 patients) were included in this overview. For these reports, the success rate for conservative treatment of appendicitis is 90.8% (88-95%) with a risk of relapse within 12 months of 15.9% (5-37%). For complicated appendicitis these mean rates decrease to 89% (67-100%) and 9.8% (0-39.6%), respectively.
Discussion and conclusions. This overview indicates that appendicitis can be safely and effectively treated conservatively. The studies differed in their treatment protocols. Appendicitis can best be treated with a third-generation cephalosporin and an imidazole derivative (2 days intravenously and 10 days orally). This is based on evidence from a combination of the studies presented here, and on expert opinion. Currently, this combination is the best available «evidence» on this topic. (Int Marit Health 2010; 61; 4: 265–272)
Keywords: appendicitisconservative treatmentantibioticsmaritime medicine
References
- Lugg DJ. Anaesthetics in Antarctica. Polar Record. 2009; 13(83): 187–190.
- Rogozov V, Bermel N. Auto-appendectomy in the Antarctic: case report. BMJ. 2009; 339: 4965.
- Norman JC. Appendicitis in submariners. US Armed Forces Med J . 1959; 10: 689–692.
- RICE BH. CONSERVATIVE, NON-SURGICAL MANAGEMENT OF APPENDICITIS. Mil Med. 1964; 129: 903–920.
- Levin T, Whyte C, Borzykowski R, et al. Nonoperative management of perforated appendicitis in children: can CT predict outcome? Pediatr Radiol. 2007; 37(3): 251–255.
- Aprahamian CJ, Barnhart DC, Bledsoe SE, et al. Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences. J Pediatr Surg. 2007; 42(6): 934–938.
- Abeş M, Petik B, Kazil S. Nonoperative treatment of acute appendicitis in children. J Pediatr Surg. 2007; 42(8): 1439–1442.
- HARRIS CW. Abraham GROVES of Fergus: the first elective appendectomy? Can J Surg. 1961; 4: 405–410.
- Fitz RH. Perforating inflammation of the vermiform appendix. Am J Med Sci. 1886; 92: 321–346.
- McBurney C. Experiences with early operative interference in cases of disease of the vermiform appendix. NY Med J. 1889; 50: 1676–1684.
- Coldrey E. Five years of conservative treatment of acute appendicitis. J Int Coll Surg. 1959; 32: 255–261.
- Ditillo MF, Dziura JD, Rabinovici R. Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg. 2006; 244(5): 656–660.
- Malik AA, Bari Su. Conservative management of acute appendicitis. J Gastrointest Surg. 2009; 13(5): 966–970.
- Hansson J, Körner U, Khorram-Manesh A, et al. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg. 2009; 96(5): 473–481.
- Styrud J, Eriksson S, Nilsson I, et al. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World J Surg. 2006; 30(6): 1033–1037.
- Bagi P, Dueholm S, Karstrup S. Percutaneous drainage of appendiceal abscess. An alternative to conventional treatment. Dis Colon Rectum. 1987; 30(7): 532–535.
- Campbell MR, Johnston SLr, Marshburn T, et al. Nonoperative treatment of suspected appendicitis in remote medical care environments: implications for future spaceflight medical care. . J Am Coll Surg. 2004; 198: 822–830.
- Eriksson S, Granstrom L. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg. 1995; 82: 166–169.
- Winn RD, Laura S, Douglas C, et al. Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics. ANZ J Surg. 2004; 74(5): 324–329.
- Adams ML. The medical management of acute appendicitis in a nonsurgical environment: a retrospective case review. Mil Med. 1990; 155(8): 345–347.
- Combined traditional Chinese and western medicine in acute appendicitis. Chin Med J (Engl. 1977; 3: 266–269.
- No authors listed] Treatment of acute appendicitis in children with combined traditional Chinese and western medicine. Chin Med J (Engl). 1977; 3: 373–378.
- Gurin NN, Slobodchuk IuS. [Characteristics of the treatment of patients with acute appendicitis on fishing boats at sea]. Vestn Khir Im I I Grek. 1988; 140(4): 32–36.
- Gurin NN, Slobodchuk IuS, Gavrilov IuF. The efficacy of the conservative treatment of patients with acute appendicitis on board ships at sea. Vestn Khir Im I I Grek. 1992; 148(5): 144–150.
- Cobben LP, de Van Otterloo AM, Puylaert JB. Spontaneously resolving appendicitis: frequency and natural history in 60 patients. Radiology. 2000; 215(2): 349–352.
- Kaminski A. Routine Interval Appendectomy Is Not Justified After Initial Nonoperative Treatment of Acute Appendicitis. Archives of Surgery. 2005; 140(9): 897–901.
- Cohen BA. A study of submarine morbidity. Submitted NUMI Qualification Thesis. Naval Undersea Medical Institute 1994.
- Lugo JZ, Avgerinos DV, Lefkowitz AJ, et al. Can Interval Appendectomy be Justified Following Conser vative Treatment of Perforated Acute Appendicitis? J Surg Res. 2009; 3: 124.
- Lai HW, Loong CC, Chiu JH, et al. Interval appendectomy after conservative treatment of an appendiceal mass. World J Surg. 2006; 30(3): 352–357.
- Oliak D, Yamini D, Udani VM, et al. Initial nonoperative management for periappendiceal abscess. Dis Colon Rectum. 2001; 44(7): 936–941.
- Brown CVR, Abrishami M, Muller M, et al. Appendiceal abscess: immediate operation or percutaneous drainage? Am Surg. 2003; 69(10): 829–832.
- Gahukamble DB, Gahukamble LD. Surgical and pathological basis for interval appendicectomy after resolution of appendicular mass in children. J Pediatr Surg. 2000; 35(3): 424–427.
- Oliak D, Yamini D, Udani VM, et al. Nonoperative management of perforated appendicitis without periappendiceal mass. Am J Surg. 2000; 179(3): 177–181.
- Yamini D, Vargas H, Bongard F, et al. Perforated appendicitis: is it truly a surgical urgency? Am Surg. 1998; 64(10): 970–975.
- Bagi P, Dueholm S. Nonoperative management of the ultrasonically evaluated appendiceal mass. Surgery. 1987; 101(5): 602–605.
- Barnes BA, Behringer GE, Wheelock FC, et al. Treatment of appendicitis at the Massachusetts General Hospital (1937-1959). JAMA. 1962; 180: 122–126.
- Bradley EL, Isaacs J. Appendiceal abscess revisited. Arch Surg. 1978; 113(2): 130–132.
- Ein SH, Shandling B. Is interval appendectomy necessary after rupture of an appendiceal mass? J Pediatr Surg. 1996; 31(6): 849–850.
- Engkvist O. Appendectomy à froid a superfluous routine operation? Acta Chir Scand. 1971; 137(8): 797–800.
- Foran B, Berne TV, Rosoff L. Management of the appendiceal mass. Arch Surg. 1978; 113(10): 1144–1145.
- Friedell ML, Perez-Izquierdo M. Is there a role for interval appendectomy in the management of acute appendicitis? Am Surg. 2000; 66(12): 1158–1162.
- Gästrin U, Josephson S. Appendiceal abscess-acute appendectomy or conservative treatment. Acta Chir Scand. 1969; 135(6): 539–542.
- Hoffmann J, Lindhard A, Jensen HE. Appendix mass: conservative management without interval appendectomy. Am J Surg. 1984; 148(3): 379–382.
- Kumar RR, Kim JT, Haukoos JS, et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum. 2006; 49(2): 183–189.
- Kumar S, Jain S. Treatment of appendiceal mass: prospective, randomized clinical trial. Indian J Gastroenterol. 2004; 23(5): 165–167.
- Mazziotti MV, Marley EF, Winthrop AL, et al. Histopathologic analysis of interval appendectomy specimens: support for the role of interval appendectomy. J Pediatr Surg. 1997; 32(6): 806–809.
- McPherson AG, Kinmonth JB. Acute appendicitis and the appendix mass. British Journal of Surgery. 1945; 32(127): 365–370.
- Mosegaard A, Nielsen OS. Interval appendectomy. A retrospective study. Acta Chir Scand. 1979; 145(2): 109–111.
- Paull DL, Bloom GP. Appendiceal abscess. Arch Surg. 1982; 117(8): 1017–1019.
- Powers RJ, Andrassy RJ, Brennan LP, et al. Alternate approach to the management of acute perforating appendicitis in children. Surg Gynecol Obstet. 1981; 152(4): 473–475.
- Samuel M, Hosie G, Holmes K. Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. J Pediatr Surg. 2002; 37(6): 882–886.
- Skoubo-Kristensen E, Hvid I. The appendiceal mass: results of conservative management. Ann Surg. 1982; 196(5): 584–587.
- Thomas DR. Conservative management of the appendix mass. Surgery. 1973; 73(5): 677–680.
- Willemsen PJ, Hoorntje LE, Eddes EHH, et al. The need for interval appendectomy after resolution of an appendiceal mass questioned. Dig Surg. 2002; 19(3): 216–220; discussion 221.
- Tekin A, Kurtoğlu HC, Can I, et al. Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass. Colorectal Dis. 2008; 10(5): 465–468.
- Bachoo P, Mahomed AA, Ninan GK, et al. Acute appendicitis: the continuing role for active observation. Pediatr Surg Int. 2001; 17(2-3): 125–128.
- Vargas HI, Averbook A, Stamos MJ. Appendiceal mass: conservative therapy followed by interval laparoscopic appendectomy. Am Surg. 1994; 60(10): 753–758.
- Carr NJ. The pathology of acute appendicitis. Ann Diagn Pathol. 2000; 4(1): 46–58.
- Arnbjörnsson E, Bengmark S. Obstruction of the appendix lumen in relation to pathogenesis of acute appendicitis. Acta Chir Scand. 1983; 149(8): 789–791.
- Luckmann R. Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age. Am J Epidemiol. 1989; 129(5): 905–918.
- Jindal N, Kaur GD, Arora S, et al. Bacteriology of acute appendicitis with special reference to anaerobes. Indian J Pathol Microbiol. 1994; 37(3): 299–305.
