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[Questionable appendectomies].

Y Flamant1, O L Zantain, J Barge

  • 1Service de chirurgie générale, hôpital Louis-Mourier, Colombes.

La Revue Du Praticien
|March 15, 1992
PubMed
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To reduce high appendectomy rates in France, observe patients with right lower quadrant tenderness if they lack rebound tenderness, guarding, have a temperature ≤38°C, and white blood cell count <10,000/mm3. This approach safely identifies appendicitis without missing perforated cases.

Area of Science:

  • General Surgery
  • Clinical Medicine

Context:

  • France performs 150,000 appendectomies annually, with an incidence four times higher than other countries.
  • A significant number of these procedures are for non-perforated or minimally inflamed appendix cases.

Purpose:

  • To propose a clinical guideline to decrease the high rate of appendectomies in France.
  • To identify patients with right lower quadrant (RIQ) tenderness who can be safely managed non-operatively.

Summary:

  • The guideline suggests observing patients with RIQ tenderness if they present without rebound tenderness or guarding.
  • Key indicators for observation include a temperature ≤38°C and a white blood cell count below 10,000/mm3.
  • Adherence to these criteria ensures that perforated or suppurated appendicitis is not missed.

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Impact:

  • Potential to significantly reduce the number of unnecessary appendectomies in France.
  • Aims to improve resource allocation in surgical departments.
  • Provides a safe and effective strategy for managing suspected appendicitis cases.