DOI: http://dx.doi.org/10.18203/2349-2902.isj20211296

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

Bhanu Bharath Naik

Abstract


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.


Keywords


Abdominal pain, Antibiotics, Appendicitis, Conservative treatment, Recurrence

Full Text:

PDF

References


Hamill JK, Hill AG. A history of the treatment of appendicitis in children: lessons learned. ANZ J Surg. 2016;86(10):762-7.

Coccolini F, Fugazzola P, Sartelli M, Cicuttin E, Sibilla MG, Leandro G, et al. Conservative treatment of acute appendicitis. Acta Biomed. 2018;89(December):119-34.

Franz MG, Norman J FP. Increased morbidity of appendicitis with advancing age. Am Surg. 1995;61(1):40-4.

Mason RJ. Surgery for appendicitis: Is it necessary? Surg Infect. 2008;9(4):481-8.

Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg. 2009;96(5):473-81.

Awe JAA, Soliman AM, Gourdie RW. Stump appendicitis: an uncompleted surgery, a rare but important entity with potential problems. Case Rep Surg. 2013;2013(25):1-4.

Gutièrrez M del C, Cefrorela N, Palenzuela SA. Carcinoid tumors of the appendix. Fet Pediatr Pathol. 1995;15(4):641-2.

Pisano M, Coccolini F, Poiasina E, Bertoli P, GiuliiCapponi M, Poletti E, et al. Conservative treatment for uncomplicated acute appendicitis in adults. Emerg Med Health Care. 2013;1(1):2.

Di Sebastiano P, Fink T, Di Mola FF, Weihe E, Innocenti P, Friess H, et al. Neuroimmune appendicitis. Lancet. 1999;354(9177):461-6.

Gedam BS, Gujela A, Bansod PY, Akhtar M. Study of conservative treatment in uncomplicated acute appendicitis. Int Surg J. 2017;4(4):1409.

Jade R, Muddebihal UM. Modified Alvarado Score and its application in the diagnosis of acute appendicitis. Int J Contemp Med Res. 2016;3(5):2454-7379.

Asger Calcuttawala M, Nirhale D, Athavale V, Malhotra M, Priyadarshi N, Lohar H. Epidemiological aspects of appendicitis in a rural setup. Med J Dr DY Patil Univ. 2014;7(6):753.

Ekka NMP. A Clinicopathological study of acute appendicitis in eastern India. Int J Med Dent Sci. 2016;5(2):1145.

Berry J, Malt RA. Appendicitis near its centenary. Ann Surg. 1984;200(5):567-75.

Rithin PS, Agarwal A, Budigi B. Evaluation of modified Alvarado scoring system in acute appendicitis at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Int Surg J. 2017;4(7):2118.

Bangla G, Rao PS. Role of Alvarado score in the diagnosis of acute appendicitis. International Journal of Research in Medical Sciences. 2013;1(4):404.

Rettenbacher T, Hollerweger A, Macheiner P, Gritzmann N, Daniaux M, Schwamberger K, et al. Ovoid shape of the vermiform appendix: A criterion to exclude acute appendicitis-evaluation with US. Radiology. 2003;226(1):95-100.

Kuzmich S, Howlett DC, Andi A, Shah D, Kuzmich T. Transabdominal sonography in assessment of the bowel in adults. Am J Roentgenol. 2009;192(1):197-212.

Rettenbacher T, Hollerweger A, Macheiner P, Rettenbacher L, Frass R, Schneider B, et al. Presence or absence of gas in the appendix: Additional criteria to rule out or confirm acute appendicitis- evaluation with US. Radiology. 2000;214(1):183-7.

Rao PM, Rhea JT, Novelline RA. Appendiceal and peri-appendiceal air at CT: prevalence, appearance and clinical significance. Brain Lang. 1997;52(10):750-4.

Alnaser MK, Hassan QA, Hindosh LN. Effectiveness of conservative management of uncomplicated acute appendicitis: A single hospital based prospective study. Int J Surg Open. 2018;10:1-4.

Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K. Antibiotics as first-line therapy for acute appendicitis: Evidence for a change in clinical practice. World J Surg. 2012;36(9):2028-36.

Vaishnav U, Chauhan H. Evaluation of conservative management of acute appendicitis in tertiary care hospital. Int Arch Integr Med. 2016;3(2):41-4.

Malik AA, Bari SU. Conservative management of acute appendicitis. J Gastrointest Surg. 2009;13(5):966-70.

Turhan AN, Kapan S, Kütükçü E, Yiğitbaş H, Hatipoğlu S, Aygün E. Comparison of operative and non-operative management of acute appendicitis. Turkish J Trauma Emerg Surg. 2009;15(5):459-62.

Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, et al. Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg. 2006;30(6):1033-7.