CONSERVATIVE TREATMENT AND FOLLOW-UP FOR ACUTE APPANDICITIS: IS EMERGENT SURGERY NECESSARY ?

Abstract

Introduction: Emergent operation is the accepted standart therapy of acute appendicitis. But conservative medical therapy is an emerging solution for acute appendicitis. We aimed to publish the conservative treatment experience of Inonu University Medical School, Department of General Surgery. Material and Method: Between January 2020 and January 2022, patients who had a clinical suspicous acute appendicitis with an Abdominal Ultrasonography or a computer tomography reporting a term ’appendicitis’ that referred to Emergency or General Surgery Department and also had a medical therapy with a non-operative approach were detected in the hospital data system. Patient demographics and clinical data analysed retrospectively. Results: Fifteen patients were detected within the 2 years period that had been received medical therapy for acute appendicitis. Median age was 32.0 (min:19 - max:70), median appendix diameter was 7.2 mm (min:5.5 - max:11.0). One patient was died due to Non-Hodgkin Lymphoma after 16 days of diagnosis of acute appendicitis. None of the patients required an operation during surveillance. Most frequent reasons for conservative treatment were not eliminating the diagnosis of pelvic inflammatory disease, inflammatory intestinal disease and urinary tract infections. Discussion and Conclusion: While some comorbidities can go along with acute appendicitis such as cardiac and systemic haematologic diseases, some of them mimic acute appendicitis such as pelvic inflamatory disease or inflamatory bowel diseases. Especially elder patients, who have a suspicous case, with a low CRP and Neutrophilia counts with an uncomplicated appendicitis, may benefit from antibiotherapy. More patients, that had an appendectomy history need to be evaluated on this aspect.