Prediction of the outcome of nonoperative management of uncomplicated acute appendicitis in adults

Document Type : Original Article

Authors

Department of Gastrointestinal & Laparoscopic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt

Abstract

Background: Antibiotic treatment may be an effective treatment modality for adult patients with acute appendicitis
(AA) and ~75% of those patients may not need appendectomy at all, either during initial illness or during the first year
of follow-up.
Aim: This clinical trial aimed to investigate the outcome (success/failure) of nonoperative management (NOM) of
uncomplicated AA in adults and to identify the independent predictors of this outcome.
Patients and Methods: A prospective cohort study was conducted at Tanta University Hospitals during the period
from July 2021 to July 2022 on 160 adult patients diagnosed with uncomplicated AA. Included patients received IV
levofloxacin and metronidazole for 72 h. Daily clinical, laboratory, and ultrasound evaluation was performed. Patients
responding successfully to NOM were discharged home while those who failed NOM were subjected to appendectomy.
Results: The study included 81 males and 79 females with a mean age of 27.6 years and a mean BMI of 23.3 kg/m2
. Total
137 (85.6%) patients showed successful outcomes of NOM during the initial admission. Multivariate analysis identified
diabetes mellitus and longer duration of symptoms before admission as independent predictors of failure of NOM. During
the 6 months follow-up, only two (1.5%) patients in the successful NOM group showed recurrent AA.
Conclusion: NOM with antibiotics in adult patients with uncomplicated AA is associated with a high success rate. diabetes
mellitus and longer duration of symptoms before admission were identified as independent predictors of failure of NOM.

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