Conservative treatment of acute appendicitis

Abstract

Objective: To define the value of Tamsulosin drug addition to antibiotics (Ceftriaxone and Metronidazole) in conservative treatment of nonperforated acute appendicitis. Patients and methods: Prospective clinical study performed in Al-Jamhoory Teaching Hospital covering a period from Jan 2010 to Jan 2012. Formal consent from the patients and ethical approval were obtained. One-hundred and two patients including 74 males and 28 females, with age range of 17-45 years were admitted to the surgical unit number 3 complaining of acute appendicitis. Detailed clinical history was taken and clinical examination was carried out. All the patients had general urine examination (G.U.E), ultra sound (U.S) of the right iliac fossa and determination of serum c.reactive protein level. Those who had complicated appendicitis were excluded from the study. The patients were randomly divided into two groups A and B. Group A: Fifty one patients were given 500 mg of Ceftriaxone and 500 mg Metronidazole, both I.V twice daily. Group B: Fifty one patients were given the antibiotics regime plus Tamsulosin 0.4 mg orally once daily. The patients who had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) in the first 24 hours of the treatment continued the treatment for further 5 days, if there was no good response immediate appendicectomy was done. There was follow up of discharged patients for 4 months. Results: Group A: Forty-one patients out of 51 (80.39%) had a good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation while 10 patients needed appendicectomy. Group B: Forty-nine patients (out of 51) 96.07% had good signs of response (decrease or disappearance of the abdominal pain, tenderness and rebound tenderness and return of appetite) within the first 24 hours post presentation and only 2 patients needed appendicectomy. Those who were discharged after conservative treatment were followed up for 4 months. Five patients in group A and 3 patients in group B had recurrence of symptoms and signs of acute appendicitis and appendicectomy was performed for them. Conclusion: Tamsulosin added to antibiotics for treatment of acute appendicitis is safe and resulted in speedy recovery of the patients with reduced recurrence of the condition. .