Nonoperative Management of Appendicitis

Appendectomy was one of the first intra-abdominal operations performed, and appendicitis has long been a surgically treated disease. Rare descriptions of nonsurgical management dot the surgical literature, however. Treves was an advocate of early nonoperative management of acute appendicitis, even prior to the advent of antibiotics. In the post-antibiotic era, Coldrey presented his retrospective series of 471 patients with appendicitis treated with antibiotics. This treatment failed in at least 57 patients, with 48 requiring appendectomy and 9 requiring drainage of an appendiceal abscess. Only one randomized controlled trial, performed by Eriksson and associates, addresses this issue. Their results show a high rate of recurrence of appendicitis treated nonsurgically. The authors randomized 40 adults with presumed appendicitis to appendectomy or 10 days of intravenous and oral antibiotics. Eight (40%) of the 20 patients in the antibiotic group required appendectomy within 1 year: one patient for perforation within 12 hours of randomization, and another 7 for recurrent appendicitis (one of whom had perforation). Based on the high rate of failure with antibiotics alone, nonoperative management of acute appendicitis cannot be recommended. Antibiotic treatment may be a useful temporizing measure, however, in environments with no surgical capabilities such as in space flight and submarine travel.