Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis

High failure rate of nonoperative management of acute appendicitis with an appendicolith in children

“…Because of concerns for patient safety with nonoperative management and the high rate of complicated appendicitis in the surgery group, the trial was halted to allow for evaluation of continuing the trial using the current inclusion and exclusion criteria. In the interim, two international pediatric trials have been published which demonstrated similarly high failure rates of nonoperative management in children with appendicitis with an appendicolith [2,11]. In a recent European randomized controlled trial of nonoperative management of children with uncomplicated acute appendicitis, 60% (3/5) of patients with an appendicolith identified preoperatively who were randomized to nonoperative treatment underwent appendectomy within 1 year [2].…”

“…In a recent European randomized controlled trial of nonoperative management of children with uncomplicated acute appendicitis, 60% (3/5) of patients with an appendicolith identified preoperatively who were randomized to nonoperative treatment underwent appendectomy within 1 year [2]. In addition, a recent prospective patient choice trial from Japan demonstrated that an appendicolith was a significant risk factor for failure of nonoperative management of appendicitis in children with 47% (9/19) failure of nonoperative management in patients with an appendicolith versus 23.7% (14/59) failure in patients without an appendicolith, p = 0.049) [11]. Across these three trials, the combined failure rate of nonoperative management of children with uncomplicated appendicitis with an appendicolith was 52%.…”

Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis

“…Additional data on inclusion and exclusion criteria and on interventions of the included studies are provided as Appendix B. Additional information was retrieved from the corresponding authors of three studies [20][21][22]. Designs of the included studies were one RCT [19], two prospective cohort studies [20,21] and two retrospective cohort studies [22,23].…”

“…-Radiological confirmation. Three studies only included children with a radiological confirmed appendicitis [20,22,23]. -Significant comorbidity.…”

Contribution of Diffusion-Weighted Magnetic Resonance Imaging in the Follow-Up of Uncomplicated Acute Appendicitis: Initial Results

“…DWI can be performed in a very short time without using any intravenous (IV) contrast media, thereby allowing fast, qualitative assessment (21)(22)(23)(24). DWI is reported to have a sensitivity of 99% and a specificity of 97% in the diagnosis of AA in adults using a b value of 500 s/mm 2 (25). In a DWI study on perforated versus nonperforated appendicitis, the apparent diffusion coefficient (ADC) values were found to be lower in perorated than in nonperforated appendicitis (26).…”