Management Strategies of Appendix with Mild Inflammation

Abstract

Ozet Abstract Amac: Akut apandisit tedavisi halen klinik bir tartismadir. Bu calismada, erken akut apandisit tanisi alan hastalarda degisik tedavi yaklasimlarini ve bunlarin takiplerini tartismayi amacladik. Yontem: Agustos 2008 ve Ocak 2010 tarihleri arasinda erken donem akut apandisit tanisi konulan 45 hasta calismaya dahil edildi ve bu hastalarin 1 yillik takip sonuclari incelendi. Bu hastalar 3 gruba randomize edildi. Birinci gruba apendektomi yapildi, ikinci gruba antibiyotik tedavisi uygulandi ve ucuncu grup ise sadece izlendi. Bulgular: 45 hastanin ortanca yasi 25 (18-52) idi. 34 hasta kadin (%75.6) ve 11 hasta (%24.4) erkek idi. Ortalama beyaz kure sayisi 7952±1698 /uL (4800-10700) olarak izlendi. Ultrasonografide ortalama apendiks duvar kalinligi 5.46±0.35 (5,0-6,0) mm olarak tespit edildi. Gruplar arasinda yas, cinsiyet, beyaz kure sayisi ve ultrasonografi sonuclari acisindan farklilik yoktu (p=0.361, 0.894, 0.708 ve 0.867). Cerrahi yapilan grubun hepsinde patoloji sonuclari akut apandisit olarak geldi. Antibiyotik tedavi grubundan 2 hasta daha sonra tekrarlayan karin agrisi sikayeti ile, biri 2 hafta sonra, digeri ise 2 gun sonra tekrar hastaneye basvurdu ve bu hastalara apendektomi yapildi, ancak patoloji raporlarinda kronik apandisit bulgusu saptanmadi. Sonuc: Apendektomi erken akut apandisit dusunulen hastalarin cogunda gerekli degildir. Objective: In this study, we examined the cases with mild acute appendicitis and their treatments with different modalities and their follow up. Method: 45 patients were studied between August 2008 and January 2010, with further follow-up for 1 year. The patients were randomly allocated into three groups by systematic random sampling with an equal size of 15 to maintain balance. First group was appendectomy group, second was antibiotic group and third group was follow up (no treatment) group. Results: The median age of the patients was 25 (18-52) years. 34 (75.6%) were women and 11 (24.4%) were men. The mean white blood cell count was 7952±1698 /uL (480010700). The mean appendix wall thickness at ultrasonography was 5.46±0.35 (5,0-6,0) mm. There were no statistical difference detected between groups in age of patients, sex, white blood cell count and ultrasonography results (p=0.361, 0.894, 0.708 and 0.867). Of the patients who underwent surgery had proven appendicitis at histological examination. Two patients treated with antibiotics were readmitted with recurrent appendicitis, one patients after 2 weeks of treatment and one patient after 2 days of treatment and were subsequently operated in the second admission. However, no chronic findings were noted at histopathological examination. Conclusion: Most of the early acute appendicitis, there is no need for appendectomy. Anahtar Kelimeler: Akut apandisit, hafif inflamasyon, antibiyotikler, takip, konservatif tedavi.