Part III: Postoperative Complications of Appendectomy (including Adhesions)

Systemic metronidazole combined with either topical povidone-iodine or ampicillin in acute appendicitis

One-hundred consecutive patients undergoing appendicectomy either electively or for clinically diagnosed acute appendicitis were studied to examine the difference between the use of topical povidone-iodine (PVP-I) and ampicillin in the wound given at the time of closure. All patients were treated with metronidazole suppositories for 48 h starting at the time of pre-medication in addition to a topical agent. The overall wound infection rate was 14%. If the appendix was histologically normal or inflamed, the rate fell to 10% whereas if gangrenous or perforated it rose to 24%. Sixty-six per cent of the patients with a perforated appendicitis developed a wound infection. There was no significant difference in the wound infection rate between those treated with PVP-I and those with ampicillin. Topical antisepsis using PVP-I is preferable to ampicillin as it abolishes the risk of antibiotic resistance or allergy developing and since it is comparatively more cost-effective.

Natural history of incidental appendectomy in patients with Crohn's disease who required subsequent bowel resection

The records of 20 patients with Crohn's disease who underwent incidental appendectomy and later required bowel resection were reviewed and the following conclusions ascertained. If the patient had had abdominal pain for less than 1 week, appendectomy is followed by minimal problems. If the patient has had abdominal pain for longer than 1 week, incidental appendectomy is followed by an 83 percent incidence of fistula or sinus tract, arising not from the appendiceal stump but from the terminal ileum. The natural history of patients with resection after appendectomy includes more medication and a higher symptom recurrence rate and perhaps operative recurrence rate than their counterparts who have not undergone incidental appendectomy.