K H Wojciechowicz1, H J Hoffkamp, R A van Hulst. 1. Maritime Medical Expertise Centre Royal Netherlands Navy, PO Box 10.000, 1780 CA Den Helder, The Netherlands. Binsi.w@gmail.com
Abstract
BACKGROUND: Although the standard treatment for appendicitis (since 1883) is an appendectomy, this is not always possible in a maritime or military setting. To avoid relying on improvisation in such situations this study examines the evidence for conservative management of appendicitis. MATERIAL AND METHODS: PubMed was searched for studies on conservative treatment of appendicitis. Both prospective and retrospective studies with a well-defined description of the protocol were included. RESULTS: Finally, 5 publications (a total of 342 patients) were included in this overview. For these reports, the success rate for conservative treatment of appendicitis is 90.8% (88-95%) with a risk of relapse within 12 months of 15.9% (5-37%). For complicated appendicitis these mean rates decrease to 89% (67-100%) and 9.8% (0-39.6%), respectively. DISCUSSION AND CONCLUSIONS: This overview indicates that appendicitis can be safely and effectively treated conservatively. The studies differed in their treatment protocols. Appendicitis can best be treated with a third-generation cephalosporin and an imidazole derivative (2 days intravenously and 10 days orally). This is based on evidence from a combination of the studies presented here, and on expert opinion. Currently, this combination is the best available "evidence" on this topic.
BACKGROUND: Although the standard treatment for appendicitis (since 1883) is an appendectomy, this is not always possible in a maritime or military setting. To avoid relying on improvisation in such situations this study examines the evidence for conservative management of appendicitis. MATERIAL AND METHODS: PubMed was searched for studies on conservative treatment of appendicitis. Both prospective and retrospective studies with a well-defined description of the protocol were included. RESULTS: Finally, 5 publications (a total of 342 patients) were included in this overview. For these reports, the success rate for conservative treatment of appendicitis is 90.8% (88-95%) with a risk of relapse within 12 months of 15.9% (5-37%). For complicated appendicitis these mean rates decrease to 89% (67-100%) and 9.8% (0-39.6%), respectively. DISCUSSION AND CONCLUSIONS: This overview indicates that appendicitis can be safely and effectively treated conservatively. The studies differed in their treatment protocols. Appendicitis can best be treated with a third-generation cephalosporin and an imidazole derivative (2 days intravenously and 10 days orally). This is based on evidence from a combination of the studies presented here, and on expert opinion. Currently, this combination is the best available "evidence" on this topic.
Authors: M J Lahaye; D M J Lambregts; E Mutsaers; B A B Essers; S Breukink; V C Cappendijk; G L Beets; R G H Beets-Tan Journal: Eur Radiol Date: 2015-01-16 Impact factor: 5.315
Authors: Giana H Davidson; David R Flum; David A Talan; Larry G Kessler; Danielle C Lavallee; Bonnie J Bizzell; Farhood Farjah; Skye D Stewart; Anusha Krishnadasan; Erin E Carney; Erika M Wolff; Bryan A Comstock; Sarah E Monsell; Patrick J Heagerty; Annie P Ehlers; Daniel A DeUgarte; Amy H Kaji; Heather L Evans; Julianna T Yu; Katherine A Mandell; Ian C Doten; Kevin S Clive; Karen M McGrane; Brandon C Tudor; Careen S Foster; Darin J Saltzman; Richard C Thirlby; Erin O Lange; Amber K Sabbatini; Gregory J Moran Journal: BMJ Open Date: 2017-11-15 Impact factor: 2.692