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