Reviewing 10 studies on more than 400 young patients, researchers found that nonsurgical treatment for an inflamed appendix appeared effective overall. But, appendicitis recurred in 14 percent of patients, and the study authors urged more research to inform doctors’ decision-making.
“It may in the future be appropriate to offer nonoperative treatment, with antibiotics, as an alternative to children with acute uncomplicated appendicitis,” said study author Dr. Nigel Hall. He’s an associate professor of pediatric surgery at the University of Southampton in England.
“However, at this stage we would not recommend that nonoperative treatment is offered as treatment outside of a carefully designed research study,” Hall added. “This is [because] we need to fully evaluate nonoperative treatment in larger numbers of children and also perform detailed comparisons … so we can better understand the relative merits of each treatment approach.”
Surgery has long been the primary treatment for appendicitis, an inflammation of the pouch-shaped organ at the lower tip of the large intestine. The condition can occur at any age, but is most common between the ages of 10 and 20, according to the study.
Appendicitis is the most common cause of acute abdominal pain requiring surgery. More than 5 percent of Americans develop appendicitis at some point in their lives, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms include fever, nausea and/or vomiting, and extreme tenderness of the abdomen.
A ruptured appendix, which releases dangerous bacteria into the abdomen, is a rare but life-threatening complication of appendicitis.
Hall and his team analyzed various prior studies reporting the use of antibiotics alone for cases of uncomplicated appendicitis in 413 children. Study designs, however, varied widely and did not all compare the same factors.
After follow-up periods ranging from eight weeks to four years, nonsurgical treatment remained effective in 79 percent of children, with appendicitis returning in 14 percent. No serious complications related to nonsurgical treatment were reported.