When is nonsurgical treatment indicated in patients with appendicitis?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Nonsurgical treatment may be useful when appendectomy is not accessible or when it is temporarily a high-risk procedure. Anecdotal reports describe the success of IV antibiotics in treating acute appendicitis in patients without access to surgical intervention (eg, submariners, individuals on ships at sea).

In a prospective study of 20 patients with ultrasonography-proven appendicitis, symptoms resolved in 95% of patients receiving antibiotics alone, but 37% of these patients had recurrent appendicitis within 14 months. [56]

The Appendicitis Acuta (APPAC) trial, which compared antibiotic therapy with appendectomy in the treatment of 530 patients with uncomplicated acute appendicitis confirmed by computed tomography (CT), was not able to demonstrate noninferiority of antimicrobial management versus surgery. [57]


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