Antibiotics for Acute Appendicitis.
Postoperative Complications; Antibiotics; Length of Stay; Decision Making; Appendectomy; Tomography; Human; Multicenter Studies; X-Ray Computed; Intravenous; Administration; Treatment Outcomes; Patient Education; Randomized Controlled Trials; Emergency Treatment; Antibiotics – Therapeutic Use; Appendicitis – Ultrasonography; Appendicitis – Drug Therapy; Appendicitis – Surgery
The article reports that patients with uncomplicated acute appendicitis can fair well without surgery as compared to clinical trial patients who underwent surgery, and states that patients had lower risk of complications during the one-year follow-up period.
Watkins Richard R
Internal Medicine Alert
2015
2015-09-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Should Acute Appendicitis Be Managed Without Appendectomy?
Medically Uninsured; Appendectomy; Office Visits; Treatment Outcomes; Abdominal Abscess; Cecal Neoplasms; Clostridium Infections; Intestinal Obstruction; Readmission; Appendicitis – Therapy
Watkins Richard R
Internal Medicine Alert
2019
2019-01-30
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Early Uncomplicated Appendicitis-Who Can We Treat Nonoperatively?
Adult; Female; Male; Aged; Young Adult; Prospective Studies; Patient Selection; Drug Administration Schedule; Appendectomy; Injections; Human; Middle Age; Adolescence; Retrospective Design; Intravenous; Administration; Oral; Treatment Outcomes; Severity of Illness Indices; Antibiotics – Therapeutic Use; Ampicillin – Therapeutic Use; Appendicitis – Diagnosis; Appendicitis – Drug Therapy; Appendicitis – Surgery; Enzyme Inhibitors – Therapeutic Use; Penicillins – Therapeutic Use
This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.
Horattas Mark C; HORATTAS ILEANA K; VASILIOU ELYA M
American Surgeon
2018
2018-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Bringing Surgeons Together Across the World: Diagnosis and Management of Acute Appendicitis
Surgery; children; safe; appendectomy
Introduction: Despite appendicitis being one of the most common surgical emergencies in the pediatric population, there is still a great deal of debate among pediatric surgeons regarding the workup and treatment. Materials and Methods: In an interactive Web symposium consisting of 130 pediatric surgeons from various regions of the world, questions about diagnosis and management of appendicitis were displayed on the screen. The audience was asked to respond to the poll questions. The questions asked to the participants pertained to an example case of a 12-year-old boy presenting to the emergency department with the classic history and exam for appendicitis. Results: The total number of respondents varied between 30 and 37, giving response rates of 23%-28%. Sixty-six percent of respondents would not order imaging. Thirty-one percent said that they would order ultrasound. No participant would order a computed tomography scan, whereas 5% would order some other form. Ninety-five percent of respondents said that they would treat the patient operatively. The majority (89%) of the participants felt comfortable waiting until morning to operate on the patient if the patient arrived at 11 p.m. Fifty-seven percent stated that they would use a three-port laparoscopic approach, and 38% would use a single port, whereas 5% would use an open surgical approach. The majority (34%) reported being able to visualize the appendix as the greatest benefit to using laparoscopy. Fifty-seven percent would give the patient one additional dose of antibiotics and then discharge him 24 hours later following treatment for acute, nonperforated appendicitis. Twenty percent of respondents would give no further antibiotics and would discharge the patient from the recovery room or soon after. Sixteen percent would not give any additional antibiotics and would discharge him 24 hours postoperatively, whereas 6% would give one additional dose of antibiotics and discharge him soon after. Conclusions: The use of virtual broadcasts affords a unique opportunity to surgeons around the world to share and learn from each other.
Craner D R; Wexler J I; Nalugo M; Ponsky T A
Journal of Laparoendoscopic & Advanced Surgical Techniques
2015
2015-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1089/lap.2014.0347" target="_blank" rel="noreferrer noopener">10.1089/lap.2014.0347</a>
Fulminant Clostridium difficile infection: An association with prior appendectomy?
Clostridium difficile; Appendectomy; Fulminant colitis
AIM: To examine if fulminant Clostridium difficile infections (CDI) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease. METHODS: A retrospective chart review was performed on patients who underwent colectomy for CDI between 2001 and 2011. The appendectomy rate was calculated based on the absence of an appendix on the surgical pathology report. This was compared to an established lifetime risk of appendectomy in the general population. A chart review was performed for mortality and traditional markers of CDI disease severity. Fisher's exact test was used to calculate the likelihood of association between prior appendectomy, mortality, and clinical markers of severity of infection. RESULTS: Fifty-five specimens were identified with pseudomembranous colitis consistent with CDI. All patients had a clinical history consistent with CDI and 45 of 55 (81.8%) specimens also had microbiological confirmation of CDI. Appendectomy was observed in 24 of 55 specimens (0.436, 99%CI: 0.280-0.606). This was compared to the lifetime incidence of appendectomy of 17.6%. The rate of appendectomy in our sample was significantly higher than would be expected in the general population (43.6% vs 17.6%, P \textless 0.01). Disease severity did not differ based on presence or absence of an appendix and no association was detected between prior appendectomy and mortality (OR = 0.588, 95%CI: 0.174-1.970). CONCLUSION: The rate of appendectomy in the patients whose CDI led to colectomy, was significantly higher than the calculated lifetime risk, suggesting an association of appendectomy and severe CDI resulting in colectomy. Larger prospective studies are needed to assess any potential causal relationships affecting fulminant CDI.
Clanton Jesse; Subichin Michael; Drolshagen Katherine; Daley Timothy; Firstenberg Michael S
World journal of gastrointestinal surgery
2013
2013-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4240/wjgs.v5.i8.233" target="_blank" rel="noreferrer noopener">10.4240/wjgs.v5.i8.233</a>