Conservative Versus Operative ManageMent of Acute Uncomplicated Appendicitis

Conservative Versus Operative ManageMent of Acute Uncomplicated Appendicitis

This study aims to compare antibiotic treatment versus surgery for patients with uncomplicated appendicitis.

The study will include patients aged 16 and over, with a first admission with right iliac fossa pain and a raised white cell count or C-reactive protein. Patients will be randomised electronically in a 1:1 ratio either to undergo emergency appendectomy or to receive intravenous antibiotics as an inpatient, until clinical and biochemical improvement is observed, followed by outpatient oral antibiotics. Those who have surgery will have 3 post-operative doses of intravenous antibiotics, unless perforation was identified at the time of surgery, in which case, microbiology will be contacted to advise regarding antibiotic choice and duration. Follow-up by telephone interview will be at 1 week, 1, 3 and 12-month intervals.

Inclusion Criteria:

• Right iliac fossa pain
• 1st episode in the past 1 year
• Raised WCC or CRP
• Fluent in English

Exclusion Criteria:

• History of inflammatory bowel disease or appendectomy
• B-HCG positive
• Significant co-morbidities
• Complicated appendicitis as proven by ultrasound, CT or MRI
• Anaphylaxis to penicillin