Outcomes of complicated appendicitis: Is conservative management as smooth as it seems? - 20/03/18
, Nina M. Neuhaus , Marcus Fluck , Joseph A. Blansfield , Marie A. Hunsinger , Mohsen M. Shabahang , Denise M. Torres , Kenneth A. Widom , Jeffrey L. Wild ⁎ Abstract |
Background |
This study characterized the failure rate of non-operative management (NOM) for complicated appendicitis (CA; perforation, abscess, phlegmon), and compared outcomes among patients undergoing acute appendectomy (AA), elective interval appendectomy (EIA), and unplanned appendectomy after failing to improve with NOM.
Methods |
Adults treated at one facility between 2007 and 2014 were retrospectively studied.
Results |
Ninety-five patients presented with CA. Sixty individuals underwent AA. The remaining 35 patients initially underwent NOM: 14 underwent EIA, nine (25.7%) failed NOM, 12 never underwent surgery.
All patients failing NOM had an open operation with most (55.6%) requiring bowel resection. AA and EIA were comparable in surgical approach, bowel resection and post-operative readmission. However, AA demonstrated a lower incidence of bowel resection (3.3% vs 17.1%, P = 0.048) when compared to all patients initially undergoing NOM.
Conclusions |
Due to the high incidence of failed NOM and the morbidity associated with failure, AA may be appropriate for CA.
Il testo completo di questo articolo è disponibile in PDF.Highlights |
• | Non-operative management failed in 25.7% of patients with complicated appendicitis. |
• | Most patients who failed non-operative management required major bowel resection. |
• | The incidence and morbidity of failed non-operative management favors acute surgery. |
Keywords : Complicated appendicitis, Perforated appendicitis, Interval appendectomy
Mappa
Vol 215 - N° 4
P. 586-592 - aprile 2018 Ritorno al numero
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