Management of patients with equivocal signs of appendicitis.

A prospective study of 418 patients referred with a tentative diagnosis of acute appendicitis was carried out to evaluate the conservative approach in patients with equivocal clinical features. One hundred and six patients (25.4%) with unequivocal signs had immediate appendicectomy. Of the remaining 312 patients, 167 were admitted to hospital for observation. Appendicectomy was performed in 28 of these patients due to progression of clinical signs during the observation period. A total of 134 patients (32%) underwent appendicectomy with an accuracy rate of 84.3%, negative laparotomy rate of 9.7% and perforation rate of 19.4%. One hundred and thirty-six patients (32.5%) with alternative diagnosis received appropriate treatment. The remaining patients improved without any specific therapy. At follow-up, recurrent symptoms requiring appendicectomy occurred in eight patients (5.4%) and appendicitis was confirmed in five (3.4%). Active observation before the decision to operate is a safe and effective approach to the management of patients with equivocal features of acute appendicitis.