[Acute appendicitis and empiric antibiotic therapy]

Acute appendicitis is a well-known disease, which was described and systematically studied in the mid-19th century. Since then, many articles, studies and even books have been written upon this subject and it seems that nothing new can be added. And still... We present 2 clinical cases of male patients, 39 and 41 years old, who were operated in the Surgical Clinic "Prof. I. Juvara" of Clinical Hospital "Dr. I. Cantacuzino" in the same month. Both had no associated pathology and have suffered, for several months, episodes of abdominal pain, fever and (one of them) diarrhea, which were not investigated, but have been treated from time to time with antibiotics, mostly cephalosporins. The physical signs of acute abdomen were very atypical and soft. Intra-operative findings consisted in both cases in tumor-like appendiceal abscesses, situated behind ileocecal junction, with local inflammation and fibrosis, suggesting a long-term evolution. The surgical solutions were typical and were followed by favorable evolutions. We present these 2 clinical cases not only for their atypical history problems, but mainly because we consider that this kind of medical attitude could become an undesirable trend, and difficult and even mistaken diagnosis would occur more frequently, which is hard to accept for a benign disease.