CONSERVATIVE TREATMENT OF ACUTE APPENDICITIS: A REVIEW OF THE LITERATURE.

Abstract

Acute appendicitis is a disease of the acute abdomen and the most common surgical condition of the abdomen. Its pathophysiology is related to obstruction of the appendix lumen caused by fecalith, lymph node hyperplasia and less frequently by parasites, neoplasms and foreign bodies, causing inflammation of the appendix. The diagnosis for the disease is clinical. The patient may present classic symptoms such as migratory abdominal pain, fever, vomiting, changes in feces and urine. Acute appendicitis is the main cause of urgent and emergency surgical intervention in general surgery in Brazil. Appendectomy is a procedure with low mortality, but it can still cause complications in up to 28% of patients, such as: wall abscess, intestinal obstruction, fecal fistula, evisceration, eventration, peritonitis and hemorrhage. In this context, the present study aimed to evaluate the effectiveness of conservative treatment in acute appendicitis. Therefore, the study is a bibliographical review, conducted by searching for articles indexed in the SciELO, PubMed and BVS databases, which had complete texts, belonging to the last 15 years, using the descriptors: “Conservative treatment of appendicitis ”, “Cost of conservative treatment of appendicitis”, “Pathophysiology”, “Diagnosis” and “Drug treatment”. Acute appendicitis is an important cause of morbidity and mortality due to the complications of this pathology, especially at extremes of age. Appendectomy is one of the most practical surgeries worldwide. However, like all surgical treatments, it also has associated risks: infection at the surgical site, intestinal obstruction and related complications in the genitourinary system. Antibiotic therapy may be an option for patients at high surgical risk and difficult surgical approaches. Although studies show a lower cure rate in patients with antibiotics than those treated surgically, there were no more surgical complications in patients operated after attempting clinical treatment, indicating that postponing surgery does not increase complications. Therefore, it was concluded that the conservative approach can be an alternative for uncomplicated and complicated appendicitis: in low levels of infection, antibiotic therapy can cure the disease in most cases, being an efficient and appropriate treatment; In more complicated cases, the use of antibiotics makes it possible to treat appendicitis and perform a late elective appendectomy.