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Clinical Management of Appendicitis
Peter Becker1, Stefan Fichtner-Feigl2, Dieter Schilling1
1Medizinische Klinik II, Diakonissenkrankenhaus Mannheim, Mannheim, Germany.
Visceral Medicine
|January 25, 2019
Summary
Antibiotic therapy is a viable option for uncomplicated appendicitis, with surgery reserved for complicated cases or treatment failures. Patient preference should guide decisions in uncomplicated appendicitis.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Clinical Therapeutics
Background:
- Appendectomy has historically been the primary treatment for acute appendicitis.
- Antibiotic therapy was previously reserved for specific circumstances.
- Recent evidence supports antibiotic therapy for uncomplicated appendicitis.
Purpose of the Study:
- To present an interdisciplinary treatment concept for acute appendicitis.
- To review the feasibility and outcomes of antibiotic therapy versus surgery.
- To inform treatment strategies based on appendicitis complexity and patient factors.
Main Methods:
- Selective literature survey in PubMed using keywords related to appendicitis and its management.
- Inclusion of author expertise and established treatment guidelines from major surgical societies.
- Development of an interdisciplinary treatment concept.
Main Results:
- Approximately 90% of patients with uncomplicated appendicitis treated with antibiotics avoid surgery initially.
- 10% of patients treated with antibiotics require a subsequent appendectomy.
- Recurrence rates for non-operated patients can be as high as 20-30% within one year.
Conclusions:
- For uncomplicated appendicitis without failure risk factors, shared decision-making with patients is recommended.
- Appendectomy remains the standard for complicated appendicitis or cases with risk factors for non-operative failure.
- Antibiotic therapy is indicated for uncertain diagnoses or mild symptoms, with surgical intervention or interval appendectomy considered for complicated cases.
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