A 35-year-old woman presents with suspected acute appendicitis (Alvarado score 7). Ultrasound is non-diagnostic. CT scan confirms a 10 mm appendix with periappendiceal fat stranding, no free fluid, and no perforation. She declines surgery. Per APPAC and CODA trial evidence, which approach is most supported?
- A Immediate appendicectomy is always mandatory regardless of patient preference
- B Non-operative management with IV antibiotics (amoxicillin-clavulanate) is an acceptable option with <30% recurrence at 1 year ✓
- C Non-operative management has 70% recurrence at 1 year making it inferior
- D Interval appendicectomy must be performed within 6 weeks regardless of resolution
Explanation
The APPAC trial (Finland) and CODA trial (US, n=1,552) both demonstrated that non-operative management with antibiotics is a safe and effective initial treatment for uncomplicated acute appendicitis, with approximately 73–80% of patients not requiring appendicectomy at 1 year (hence <30% recurrence requiring surgery). The CODA trial showed comparable quality of life and similar complication profiles. Patients with appendicoliths had higher recurrence rates and may be better served by early surgery. Non-operative management is a valid shared decision-making option for uncomplicated CT-confirmed appendicitis. Mandatory surgery disregards patient-centered evidence-based care.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.