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Conservative treatment of acute appendicitis: an overview
K H Wojciechowicz1, H J Hoffkamp, R A van Hulst
1Maritime Medical Expertise Centre Royal Netherlands Navy, PO Box 10.000, 1780 CA Den Helder, The Netherlands. Binsi.w@gmail.com
Background:
Although the standard treatment for appendicitis (since 1883) is an appendectomy, this is not always possible in a maritime or military setting. To avoid relying on improvisation in such situations this study examines the evidence for conservative management of appendicitis.
Material And Methods:
PubMed was searched for studies on conservative treatment of appendicitis. Both prospective and retrospective studies with a well-defined description of the protocol were included.
Results:
Finally, 5 publications (a total of 342 patients) were included in this overview. For these reports, the success rate for conservative treatment of appendicitis is 90.8% (88-95%) with a risk of relapse within 12 months of 15.9% (5-37%). For complicated appendicitis these mean rates decrease to 89% (67-100%) and 9.8% (0-39.6%), respectively.
Discussion And Conclusions:
This overview indicates that appendicitis can be safely and effectively treated conservatively. The studies differed in their treatment protocols. Appendicitis can best be treated with a third-generation cephalosporin and an imidazole derivative (2 days intravenously and 10 days orally). This is based on evidence from a combination of the studies presented here, and on expert opinion. Currently, this combination is the best available "evidence" on this topic.
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