What is the risk of an appendiceal rupture in appendicitis?

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

A retrospective study suggested that the risk of appendiceal rupture is minimal in patients with less than 24-36 hours of untreated symptoms, [59] and another retrospective study suggested that appendectomy within 12-24 hours of presentation is not associated with an increase in hospital length of stay, operative time, advanced stages of appendicitis, or complications compared with appendectomy performed within 12 hours of presentation. [60]

Fair et al used data from the American College of Surgeons National Surgical Quality Improvement Project to evaluate 30-day morbidity and mortality of intervention (laparoscopic and open appendectomy) at different time periods (adjusted for preoperative risk factors) and found similar outcomes between when appendectomy was performed within 24 hours and when it was performed between 24-48 hours. [61]  However, a delay of operative intervention longer than 48 hours was associated with doubling of complication rates.

In a separate study, Boomer et al reported that delaying appendectomy (16 hours from presentation in the emergency department or 12 hours from inpatient admission) in children did not result in higher rates of surgical site infections. [62]

Additional studies are needed to demonstrate whether initiation of antibiotic therapy followed by urgent appendectomy is as effective as emergent appendectomy for patients with unperforated appendicitis.

Go to Appendectomy and Pediatric Appendectomy for more information on these topics.


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