The Role of Conservative Management of Modified Moderate Alvarado Score(4-7) in Acute Appendicitis

Abstract

Background: Reginald Fitz described appendicitis  in 1886.1From then the term appendicitis has been used. Acute appendicitis is the  Commonest cause of abdominal surgical intervention with a  prevalence of nearly  1 in 7 people[2].It is related to  occasional mortality and  high morbidity. Regarding conservative management an initial non-operative management for acute appendicitis was tried  in the 1950s but was not accepted at that time[16] .Conservative management of acute appendicitis is safe and associated with reduced rate of operation ,complication and reduced costs of treatment[17-18]. Treatment include bowel rest, intravenous antibiotic with3rd generation Cephalosporine and Metronidazole .Datas show successful result in 90% of patients in whom appendicitis was confirmed by CT however 1/4 of patients may require surgical intervention within one year [19].

Objective: To assess the role of conservative management of acute appendicitis in  patients with Modified Moderate Alvarado Score of (4-7).

Patients and Methods: This is a prospective study conducted in Sulaymanya Teaching Hospital from December 2017 to December  2018 .A total number of 100 cases of acute appendicitis who were admitted in the emergency department with Modified Moderate  Alvarado score (4-7)had  been included. All the cases of the study  were collected and all these patients received treatment  and they divided into two groups according to the  response and failure  of treatment . Group A consist of ( 59%) patients in whom conservative treatment  had been succeeded  group B included  (41%) patients  in whom conservative  treatment  had been failed . The two groups were comparable  according  to age, gender and  comorbidity . Inclusion crieteria include  patients with Alvarado score  ( 4-7). Exclusion crieteria include  patients with high and low Alvarado Score , Appendicular Abscess, Appendicular mass, Fecolith, pregnant ladies, ectopic pregnancy and ovarian cyst.

Results: Finally a total 100   patient were included in this study the  success rate of conservative treatment  of Acute Appendicitis was     59 %  the failure rate was   41  %.

Conclusion: in this study the result indicate that  Conservative management of acute appendicitis  of Modified  Moderate Alvarado Score (4-7) is safeand reduces  the rate of  non-indicated surgery and reduces the rate of  morbidity related to  operation from those selected patients, and in this study the result also indicates that conservative management is successful in cases with Modified Moderate Alvarado score(4-7).