[Acute appendicitis - recent controversies in diagnostic and therapy]

Acute appendicitis - recent controversies in diagnostic and therapy Abstract. Acute appendicitis is one of the most frequent surgically treated gastrointestinal diseases. For most of the patients it is supposed to be easily diagnosed and treated, but there are cases with complex diagnosis and indistinct treatment. For correct diagnosis an elaborated patients' history and clinical examination by an experienced surgeon is necessary. In many countries, patients undergo additional extensive radiological diagnostics beside of ultrasound. This fact leads to an unjustified risk of x-ray exposure and increased costs in the health care system. In contrast, delay during diagnosis and treatment and consecutive complications are often the trigger for legal dispute and the accusation of malpractice of the responsible surgeon. In addition, the treatment of acute appendicitis has undergone changes towards a non-surgical therapy, so that the routinely performed urgent appendectomy has been displaced by conservative therapy using antibiotics, percutaneous drainage, and interval surgery after a certain time in a non-inflammatory state. So far, no distinct guideline is available, as profound prospective and randomized results and subgroup analysis are still missing. In this article these problems and controversies are enlightened. Particularly, legal aspects and potential conflicts between family doctors, surgeons, relatives, and patients are discussed. Finally, nothing is easy to diagnose or treat, even potentially simple diseases as acute appendicitis is considered to be.