Nonoperative management of perforated appendicitis without periappendiceal mass.
BACKGROUND
Initial nonoperative treatment for patients with periappendiceal mass has been shown to be safe and effective. Our goal was to evaluate the safety and efficacy of initial nonoperative management for perforated appendicitis not accompanied by a palpable mass.


METHODS
The study population consisted of 77 patients with appendicitis treated initially nonoperatively between 1992 and 1998. All had localized abdominal tenderness and computed tomography findings of abscess or phlegmon. None had a palpable abdominal mass. Outcome parameters evaluated were rate of failure, complication, and recurrence.


RESULTS
There were 49 males and 28 females with a mean age of 35 years (range 16 to 75). Initial nonoperative management was successful in 95% of patients. Complications occurred in 12% of patients. Recurrent appendicitis developed in 6.5% of patients after an average follow-up of 30 weeks.


CONCLUSIONS
Perforated appendicitis patients with localized abdominal tenderness and abscess or phlegmon can safely and effectively be treated in an initial nonoperative fashion.
Oliak
D
D
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
Yamini
D
D
Udani
V M
VM
Lewis
R J
RJ
Vargas
H
H
Arnell
T
T
Stamos
M J
MJ
D018784:Abdominal Abscess / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000145:classification; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000628:therapy*; D001065:Appendix / Q000473:pathology; D002481:Cellulitis / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010173:Palpation; D012008:Recurrence; D012449:Safety; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome