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Vol 62, No 4 (2010)
MARITIME MEDICINE Review articles
Submitted: 2013-02-18
Published online: 2011-02-24
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Conservative treatment of acute appendicitis: an overview

K.H. Wojciechowicz, H.J. Hoffkamp, R.A. van Hulst
International Maritime Health 2010;62(4):265-272.

open access

Vol 62, No 4 (2010)
MARITIME MEDICINE Review articles
Submitted: 2013-02-18
Published online: 2011-02-24

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)

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)
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Keywords

appendicitis; conservative treatment; antibiotics; maritime medicine

About this article
Title

Conservative treatment of acute appendicitis: an overview

Journal

International Maritime Health

Issue

Vol 62, No 4 (2010)

Pages

265-272

Published online

2011-02-24

Bibliographic record

International Maritime Health 2010;62(4):265-272.

Keywords

appendicitis
conservative treatment
antibiotics
maritime medicine

Authors

K.H. Wojciechowicz
H.J. Hoffkamp
R.A. van Hulst

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