Abstract
Background: Conservative (non-operative) management of acute appendicitis is becoming more accepted in routine clinical practice. However, conservative management is unable to treat all cases of acute appendicitis. On the other hand, operative management does not avoid negative, or unnecessary, appendectomy. In this study, we evaluated objective examination methods that would help clinicians to decide correctly conservative or operative management. Methods: This study was a single-center retrospective analysis of a Japanese medical insurance database. Data for 124 patients with acute appendicitis were retrieved and analyzed. Objective examinations included age, sex, computed tomography (CT), medical history, and blood laboratory data. Logistic regression analysis was used to identify factors associated with successful conservative management and negative appendectomy. Results: History of successful conservative management, negative finding of an enlarged appendix on CT images, and the absence of fecal stones in the appendix on CT images were significantly associated with successful conservative management (p=0.018, 0.006, and 0.044, respectively). Also a negative finding of enlarged appendix on CT images and low neutrophil sequestration were significantly associated with negative appendectomy (p<0.001 and 0.007, respectively). Conclusions: The negative finding of enlarged appendix on CT images was an important predictor for accurate selection of conservative and operative management of acute appendicitis.
