Adnan HASLAK, Zeynep BAHCE SENER, Beyza Ozc ınaR, Ramazan BUYUKKAYA

Hafif inflamasyonlu apendisitte tedavi yaklaşımları

AMAÇ: Akut apandisit tedavisi halen klinik bir tartışmadır. Bu çalışmada, erken akut apandisit tanısı alan hastalarda değişik tedavi yaklaşımlarını ve bunların takiplerini tartışmayı amaçladık.YÖNTEMLER: Ağustos 2008 ve Ocak 2010 tarihleri arasında erken dönem akut apandisit tanısı konulan 45 hasta çalışmaya dahil edildi ve bu hastaların 1 yıllık takip sonuçları incelendi. Bu hastalar 3 gruba randomize edildi. Birinci gruba apendektomi yapıldı, ikinci gruba antibiyotik tedavisi uygulandı ve üçüncü grup ise sadece izlendi. BULGULAR: 45 hastanın ortanca yaşı 25 18-52 idi. 34 hasta kadın %75.6 ve 11 hasta %24.4 erkek idi. Ortalama beyaz küre sayısı 7952±1698 /uL 4800-10700 olarak izlendi. Ultrasonografide ortalama apendiks duvar kalınlığı 5.46±0.35 5,0-6,0 mm olarak tespit edildi. Gruplar arasında yaş, cinsiyet, beyaz küre sayısı ve ultrasonografi sonuçları açısından farklılık yoktu p=0.361, 0.894, 0.708 ve 0.867 . Cerrahi yapılan grubun hepsinde patoloji sonuçları akut apandisit olarak geldi. Antibiyotik tedavi grubundan 2 hasta daha sonra tekrarlayan karın ağrısı şikayeti ile, biri 2 hafta sonra, diğeri ise 2 gün sonra tekrar hastaneye başvurdu ve bu hastalara apendektomi yapıldı, ancak patoloji raporlarında kronik apandisit bulgusu saptanmadı.SONUÇ: Apendektomi erken akut apandisit düşünülen hastaların çoğunda gerekli değildir.

Anahtar Kelimeler:

Akut apandisit, hafif inflamasyon, antibiyotikler, takip, konservatif tedavi

Management Strategies of Appendix with Mild Inflammation

OBJECTIVE: In this study, we examined the cases with mild acute appendicitis and their treatments with different modalities and their follow up. METHODS: 45 patients were studied between August 2008 and January 2010, with further follow-up for 1 year. The patients were randomly allocated into three groups by systematic random sampling with an equal size of 15 to maintain balance. First group was appendectomy group, second was antibiotic group and third group was follow up no treatment group. RESULTS: The median age of the patients was 25 18-52 years. 34 75.6% were women and 11 24.4% were men. The mean white blood cell count was 7952±1698 /uL 4800-10700 . The mean appendix wall thickness at ultrasonography was 5.46±0.35 5,0-6,0 mm. There were no statistical difference detected between groups in age of patients, sex, white blood cell count and ultrasonography results p=0.361, 0.894, 0.708 and 0.867 . Of the patients who underwent surgery had proven appendicitis at histological examination. Two patients treated with antibiotics were readmitted with recurrent appendicitis, one patients after 2 weeks of treatment and one patient after 2 days of treatment and were subsequently operated in the second admission. However, no chronic findings were noted at histopathological examination. CONCLUSION: Most of the early acute appendicitis, there is no need for appendectomy.

Keywords:

Acute appendicitis, mild inflammation, antibiotics, follow up, conservative management,

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