Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy
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Minim Invasive Ther Allied Technol · Jan 2011
ReviewClinical suspicion of acute appendicitis - is the time ripe for more conservative treatment?
Traditionally, the diagnosis of acute appendicitis has been based mainly on a history compatible with acute appendicitis and pain at McBurney's point, and the treatment of choice in patients with right iliac fossa pain referring to acute appendicitis has been (laparoscopic) appendicectomy. In too many centers where these traditional rules are followed the accuracy of diagnosis of acute appendicitis still remains at the level of 80 to 85%. It is time to re-evaluate these general guidelines. ⋯ Although there is a clinical suspicion of acute appendicitis, it can be excluded in adult patient, if both leucocyte count and C-reactive protein value are normal on admission to hospital and remain normal in the follow-up. In expert centers, up to 100% sensitivity and specificity have been reported for contrast-enhanced multidetector computed tomography in the diagnosis of acute appendicitis. Antibiotic treatment can be considered a safe first-line therapy in selected patients with acute appendicitis.