title: Appendicolith delays resolution of appendicitis following nonoperative management.
abstract: BACKGROUND
  Success in nonoperative management is only based on the clinical symptoms of patients with acute appendicitis. However, imaging studies can provide further insight into the status of the appendix to monitor treatment response if immediate appendectomy is not undertaken. This study investigates sonographic resolution following nonoperative management and assesses the feasibility of incorporating ultrasound into patient care.
  
  
  METHODS
  Adult patients with acute appendicitis who had been successfully treated with nonoperative management were enrolled and received repeat sonographic examinations using 3-day intervals until sonographic resolution. The relationship between the time to achieve sonographic resolution and clinical parameters was identified using negative binomial regression models.
  
  
  RESULTS
  From January 2003 to December 2009, 128 patients were successfully treated with nonoperative management. Eighty patients completed sonographic examinations until achieving resolution. Sonographic resolution was achieved on 17 ± 12 days (range, 3-69 days). Ninety-five percent of the patients achieved sonographic resolution within 41 days. The appendicolith was positively related to the time to achieve sonographic resolution (rate ratios, 1.63; 95 % confidence intervals, 1.06-2.51).
  
  
  CONCLUSIONS
  Ultrasound can be used to evaluate the condition of the appendix to monitor treatment response following nonoperative management on the sixth week. An appendicolith delays sonographic resolution of appendicitis.
authors.affiliation: Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Wan-Ching
authors.initials: WC
authors.lastname: Lien
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.forename: Kao-Lang
authors.initials: KL
authors.lastname: Liu
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
mesh_terms: D001064:Appendicitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D001065:Appendix; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D002429:Cecal Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography