Antibiotics vs Surgery in Appendicitis
Dr. Erik Fossen
The inspiration behind choosing this article came from a case I had in the Emergency Department involving acute uncomplicated appendicitis. The patient was a 30-year-old male who did not want to be admitted for surgery because he had too many obligations at work and at home. He asked if there was an outpatient option that would allow him to defer the appendectomy to a later date.
14 of the 15 adult patients met the stable discharge criteria. The one adult that was admitted was discharged the next day following administration of his second ertapenem dose. One pediatric patient was also admitted for antibiotics.
There was one re-occurrence of appendicitis 18 days out that was successfully treated with antibiotics.
At one year follow up, 2 patients had re-occurrence of appendicitis and one required an appendectomy. The other received antibiotics.
Secondary outcomes showed shorter interval to being pain free, decrease in overall hospital time and quicker return to baseline activity.
Laparoscopic surgery performed on 9 of 14 patients (64%) and open appendectomy performed on 5 of 14 patients (36%).
The two major complications of surgery included trocar induced retroperitoneal hemorrhage requiring a blood transfusion and post-operative abscess 5 days following surgery requiring drainage.
No major complications found 1 year out.