The Study of Non Operative Treatment for Acute Appendicitis (NOTA)

Abstract

Management of patients in emergency departments is an important indicator of the quality of a healthcare system. In selected patients with acute appendicitis can we treat them by antibiotic therapy alone? The study aimed to assess the long-term efficacy of non-operative treatment in the management of uncomplicated acute appendicitis. A Prospective Cohort study was carried out in a periphery hospital, it included adult female patients satisfied the research criteria (January 2017 to December 2018). Those were including the clinical signs and symptoms of acute appendicitis, and radiological findings suggestive for acute appendicitis. Nonsurgically treated patients were divided in two groups based on the treatment outcome either successful or unsuccessful. It included 52 patients their mean age was 25.2±9.7 years. The majority were from the age group > 20 -30 years (46.2%). All had right iliac fossa pain, tenderness and rebound tenderness. Only in 43 (82.7%) patients the ultrasound was diagnostic. All patients received combined antibiotics in the form of intravenous 3 rd generation Cephalosporin 1 gm twice a day and Metronidazole 500 mg three times a day. Successful cases were discharged on oral antibiotics for further 7 days. Successful, failure and recurrence rate were 93.8%, 7.69% and 6.3% respectively. Satisfaction questionnaire was filled by patients who treated conservatively and it revealed that 96.2% were satisfied from such type of management. In conclusion, the use of antibiotics for suspected acute non complicated appendicitis is effective and may avoid unnecessary appendectomy. Once nonsurgical management is started, close monitoring of patient's clinical condition is mandatory.