Emergency surgery updates in the management of appendicitis, cholecystitis, and intestinal perforations
Year: 2025
Type: article
Abstract: To review and synthesize updates (last five years) in the surgical and non-surgical management of acute appendicitis, acute cholecystitis, and intestinal perforations, emphasizing indications, timing of intervention, the role of antibiotic therapy, source control, and management in septic patients. Methods: Narrative review of guidelines, randomized controlled trials, meta-analyses, and systematic reviews indexed in PubMed/PMC, SciELO, and international databases between 08/2020 and 08/2025. Results: (1) Appendicitis: Appendectomy remains the standard in most scenarios; however, non-operative antibiotic therapy is a selected option for uncomplicated appendicitis with well-defined criteria. Recent evidence shows higher recurrence rates but lower immediate morbidity in some RCTs. (2) Acute cholecystitis: A consolidated trend toward early cholecystectomy (preferably laparoscopic) in operable patients, guided by severity classification (Tokyo Guidelines), with percutaneous drainage/cholecystostomy as an option for high-risk patients. (3) Intestinal perforations/peritonitis: Emphasis on early source control, aggressive resuscitation, and “damage control” strategies when indicated; limited role for open abdomen, reserved for specific situations. Conclusion: Modern management favors individualized decisions integrating risk stratification, diagnostic imaging, guided empirical antibiotic therapy, and early source control; gaps remain regarding optimal selection for non-operative treatment in appendicitis and early criteria for “damage control” surgery.
Authors: Oliveira, Davi Mota Candido de, Silva Junior, Eduardo Abrão da, Barbosa, Paulo Henrique, de Liandro, Wanessa Gabriela, Prudente, Sumaya Vieira Canedo, Menezes, Luna Santos de, Rodrigues, Luiz Antônio Rosa Simão
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7084922606
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