acute appendicitis

Last edited 08/2023 and last reviewed 08/2023

Acute appendicitis is one of the most common causes of an acute abdomen in the Western world. In 90% of cases the infection develops as a result of obstruction of the appendix, for example, by a faecolith or an engorged lymphoid system, for example by a viral infection.

It is the most common surgical emergency of childhood, with three or four children per 1000 having their appendix removed every year.

This condition can occur at any age but in children it is most often seen over five years of age.

Comparing antibiotic treatment and appendicectomy for acute appendicitis (1,2)

• surgical appendicectomy remains the best treatment for acute appendicitis in patients fit enough for surgery (1)
• athough antibiotic treatment can be effective in patients with uncomplicated appendicitis some will still require surgery, which may be more extensive if antibiotics fail and surgery is delayed, and there is a substantial risk of recurrence (1)
  • is possible to categorize acute appendicitis as complicated or uncomplicated (2)
    • an abscess, phlegmon, or perforation are consequences of complicated appendicitis
  • antibiotic regimes in acute uncomplicated appendicitis (2)
    • most popular combination is cephalosporin with nitroimidazole, followed by quinolones and penicillin with a beta-lactamase inhibitor
• up to 30% of patients treated with firstline antibiotics will require surgery, and there is a substantial risk of recurrence (1)
• delaying surgery increases the risks of more extensive intervention with associated costs for patients and health system (1)

Reference:

• Malik A K, Innes A H, Reddy L, Munro C, Phillips A W. Appendicectomy remains treatment of choice for patients with acute appendicitis BMJ 2023; 382 :e074652 doi:10.1136/bmj-2022-0746524
• Yadao S, Lamture Y, Huse S. Uses of Antibiotics Alone in Case of Uncomplicated Appendicitis. Cureus. 2022 Aug 27;14(8):e28488. doi: 10.7759/cureus.28488. PMID: 36176829; PMCID: PMC9513284