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January 11, 2021

Evolving Issues in the Use of Antibiotics for the Treatment of Uncomplicated Appendicitis

Author Affiliations
  • 1Center for Surgical Outcomes Research, Abigail Wexner Research Institute and the Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
JAMA. 2021;325(4):351-352. doi:10.1001/jama.2020.23607
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    3 Comments for this article
    Non-Operative Management of Appendicitis
    John Waldron, MD | Marshfield Clinic, retired
    I hope on-going studies count the number of subsequent CT scans of abdomen in the operative and non-operative groups.
    Role of fecalomas?
    Harald Aanning, MD | Retired
    Only when we apprised our pathologist of our observing soft but formed intraluminal fecal matter in otherwise normal appendixes resected for suspicion of appendicitis, with pain and tenderness to palpation over McBurney's point, did the pathology reports include that finding.

    Previously, the appendiceal contents were invariably washed down the sink with only "palpable" fecal matter - fecaliths - being noted.

    It raises the question of the role of antibiotics in the treatment of suspected uncomplicated appendicitis when non-calcified fecalomas are present in the lumen.
    Conservative Management of Appendicitis
    Lester Katz, MBBCH, MD | University Hospital
    I do not think we should consider a 30 per cent one year follow up failure in the conservative group a success. There is no mention of possible infertility in the groups related to ongoing infection in young women; also, the use of prolonged antibiotics must exacerbate the incidence of C. dificile infection, and there is no mention of missing a tumor in the appendix. I wonder if the move to conservative treatment of appendicitis is related to the emergency and inconvenient timing of the surgery in a world of low physician reimbursement. I would think that most surgeons would choose an outpatient laparoscopic appendectomy for themselves or their family members.