Operative Versus Non-Operative Management for Appendicitis With Abscess or Phlegmon
Yale University
Summary
The investigators aim to determine if early operative intervention is superior to non-operative management for adult patients with computerized tomography (CT)-proven complicated appendicitis with phlegmon or abscess.
Description
Complicated appendicitis with abscess or phlegmon represents a challenging problem to emergency general surgeons, and the preferred treatment remains controversial. A variety of therapies have been recommended including early operative intervention, delayed operative intervention, and non-operative management. Recently, a prospective randomized controlled trial from a single center was conducted in Finland comparing operative and non-operative management of appendiceal abscess. Patients managed in the operative arm were found to have a shorter length of stay, fewer re-admissions, and fewer add…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1\. Complicated appendicitis with presumed perforation on (computer tomography) CT scan AND phlegmon or abscess greater than 2 centimeter (cm). Exclusion Criteria: 1. Antibiotic therapy greater than 24 hours prior to considering for enrollment. 2. Attempted drainage before randomization 3. Pregnancy 4. Antibiotic allergy requiring the use of something other than a beta-lactam or quinolone based therapy. 5. Previous major intra-abdominal surgery by laparotomy 6. Hospitalization within 2 weeks of randomization 7. Presence of septic shock on admission. 8. Mechanical ventila…
Interventions
- ProcedureOperative management
Surgery for computer tomography (CT)-proven complicated appendicitis with phlegmon or abscess.
- OtherDrainage or antibiotics
If an abscess is present and amenable to percutaneous drainage this will be performed. If there is no abscess or it is not amenable to drainage antibiotics alone will be provided.
Location
- Yale New Haven HospitalNew Haven, Connecticut