A young man presents with a slam dunk appendicitis. You start IV abx, order pre-op labs and request surg to come see the patient. Surgery chats with the young fellow, lays hands on his abd and reviews the labs and CT. They recommend IV abx x24-48hours and no surgery if no worsening. Your med student looks puzzled. “Isn’t the treatment for appendicitis an appendectomy?”

 

Could be. Or you could try just antibiotics. Surgery is not w/o complications and in poor and underdeveloped countries, abx sans surgery is the way to go for “uncomplicated appy,” given the risk of poor outcomes w/surgical intervention. However, recurrence rates are pretty high.

Ref: Varadhan K, et al. Safety and efficacy of antibiotics compared with appendicetomy for treatment of uncomplicated appendicitis: meta-analysis of randomised controlled trials. BMJ 2012; 344:e2156

May 2024
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