Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan.
This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months.
90 patients were evaluated, 54 (60%) patients were female and 36 (40%) patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6%) patients and failed in 22 (24.4%) patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients), appendicular abscess (3 patients) and appendicular mass (4 patients).
Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery.
