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Perforated appendicitis: is it truly a surgical urgency?
D Yamini1, H Vargas, F Bongard
1Department of Surgery, Harbor-University of California at Los Angeles Medical Center, Torrance 90509, USA.
The American Surgeon
|October 9, 1998
Summary
Conservative management for perforated appendicitis is safe and effective. Most patients with localized abscess or phlegmon improve without surgery, and interval appendectomy has low morbidity.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Infectious Disease Management
Background:
- Perforated appendicitis with localized findings traditionally treated with surgery or drainage.
- Nonoperative management followed by interval appendectomy (IA) for perforated appendicitis is debated.
Purpose of the Study:
- To assess the safety and efficacy of conservative management for perforated appendicitis with localized abscess or phlegmon.
- To evaluate the outcomes of nonoperative therapy followed by interval appendectomy.
Main Methods:
- Retrospective 5-year review of patients with perforated appendicitis treated conservatively.
- Initial treatment with intravenous antibiotics; CT-guided drainage reserved for non-responders.
- Interval appendectomy recommended for patients responding to conservative therapy.
Main Results:
- 92% of 66 patients with localized abscess or phlegmon improved without surgery.
- Only 58% of abscesses required percutaneous drainage.
- Interval appendectomy in 41 patients showed 10% morbidity and short hospital stays.
Conclusions:
- Conservative management is a safe and effective option for perforated appendicitis with localized findings.
- Percutaneous drainage is often unnecessary.
- Interval appendectomy is associated with low morbidity and brief hospitalization.