Nonoperative management of acute appendicitis

Date posted: August 14, 2014

The great majority of patients with acute appendicitis are managed with appendectomy. However, nonoperative management may be a reasonably effective alternative for carefully selected individuals with acute uncomplicated appendicitis as it is for acute uncomplicated diverticulitis. In a prospective study of 159 adults and older adolescents with suspected acute, nonperforated appendicitis who were treated with amoxicillin-clavulanate, treatment failure warranting surgical intervention within the first seven days occurred in 11.9 percent [3]. After two years of follow-up, the recurrence rate was 13.8 percent, and many of those with recurrent disease were successfully managed with an additional course of antibiotics. Nevertheless, we favor surgical management in almost all patients because of the low morbidity and exceedingly low mortality associated with appendectomy and the appreciable potential for complications and recurrence with medical management.

Reference

See “Acute appendicitis in adults: Management”, section on ‘Nonoperative management’

3. Di Saverio S, Sibilio A, Giorgini E, et al. The NOTA Study (Non Operative Treatment for Acute Appendicitis): Prospective Study on the Efficacy and Safety of Antibiotics (Amoxicillin and Clavulanic Acid) for Treating Patients With Right Lower Quadrant Abdominal Pain and Long-Term Follow-up of Conservatively Treated Suspected Appendicitis. Ann Surg 2014; 260:109.

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