Effectiveness of Non operative Treatment in Acute Appendicitis

Background: Acute Appendicitis is one of the most common presentation on surgical floor and Appendectomy is one of the most common emergency operation being done worldwide. Although emergency appendicectomy is consider as standard treatment for acute appendicitis but acute appendicitis can also be managed by non operative means in carefully selected/closely observed pts. Methods: Patients presented with clinically suggestive Appendicitis during my emergency on call duties in King Fahad Hospital Al baha (KFH), KSA from Aug.2011 to Aug. 2012 were selected for the conservative treatment by means of NPO, I/V fluids. More over selected patients were also subjected to single shot of cefuroxime and flagyl. These were adult patients with age ranging from 12 to 80 years. The success rate, conversion rate, recurrence, morbidity and mortality was evaluated. The criteria of inclusion were suggestive clinical features of acute appendicitis, first time presentation, patients with age 12 or above and Alvarado’s score 5 or above. Whereas criteria of exclusion were patients with clinical features of complicated appendicitis, recurrent disease, or diabetic. The patients were observed 6 hourly intervals for further consideration regarding conservative treatment and subsequently discharge home or converted for operation. The discharged patient with non operative management was followed up for one year in follow up clinic, ER and through medical record. Results: Out of 305 patients admitted with provisional diagnosis of acute appendicitis, 176(57.71%) patients were selected for conservative treatment,102(58%)female and 74(42%) were male Conservative treatment was proven successful in 150(85.23%) patients, while failed in 26(14.77%) patients out of 176 selected for non operative management. So out of 305 patients admitted with provisional diagnosis of acute appendicitis, 150(49.18%) were successfully treated by non operative means. It means that almost half of the patients with acute appendicitis can be selected for non operative management with or without antibiotics. Conclusion: Non operative management in acute appendicitis is a successful alternative option in carefully selected cases through closed observation and regular monitoring. There is acceptable risk of recurrence and complication.