Role of Delay and Antibiotics on Perforation Rate While Waiting Appendectomy
Role of Delay and Antibiotics on Perforation Rate While Waiting Appendectomy
This study evaluates the effects of preoperative delay and antibiotics on perforation rate of
 appendix while waiting surgery for acute appendicitis. Patients with diagnosed acute
 appendicitis are randomized into two urgency groups: surgery within 8 hours or surgery within
 24 hours. In addition, patients are randomized to either receive antibiotics while waiting or
 waiting without antibiotics.
Inclusion Criteria:

 -  Acute appendicitis where surgery is planned. Diagnosis of appendicitis should be
 verified either by clinical diagnosis with Adult Appendicitis Score >=16 or by
 diagnostic imaging (CT-scan, MRI or ultrasound) showing appendicitis. All patients
 with symptoms at least 3 days should undergo diagnostic imaging before inclusion.

 Exclusion Criteria:

 -  Complicated appendicitis according to diagnostic imaging. The following findings
 indicate complicated appendicitis: extraluminal air or extraluminal fecalith; fluid
 collection, abscess or phlegmon next to appendix; non-enhancement appendiceal wall on
 contrast enhanced CT-scan.

 -  Plasma C-reactive protein >=100

 -  Fever measured on emergency department over 38.5 degrees Celcius.

 -  Clinical generalized peritonitis or other reason that indicate immediate surgery

 -  Pregnancy, pregnancy test is taken from all fertile aged women before randomization

 -  Allergy to study antibiotics, or anaphylactic reaction after betalactam antibiotic or
 other contraindication for metronidazole or ongoing antibiotic treatment or patient is
 carrier of resistant bacteria. (This exclusion criteria are applicable only on
 randomization into antibiotic treatment arms)

 -  Missing written informed consent