The management of the perforated appendix: A controlled clinical trial

Abstract

Abstract Seventy-one patients with peritonitis due to perforation of the appendix were treated by preoperative rectal metronidazole, appendicectomy and omission of skin closure. They were then randomized to have either no further antibacterial treatment, or rectal metronidazole twice-daily for 5 days. No major wound infections occurred, but 8 patients developed intraperitoneal abscesses. In addition, I died of a pulmonary embolus and 1 required further laparotomy for intestinal obstruction. Patients in the 5-day-metronidazole group suffered fewer intraperitoneal abscesses and less pyrexia, but the differences did not achieve statistical significance. This series shows a considerable improvement over a previously published series in terms of morbidity, duration of pyrexia and length of hospital stay.