[The value of metronidazole in the indications for appendicectomy in a tropical environment. Apropos of 183 cases]

This work was carried out consequently to three observations followed up by regrettable consequences: one right hemicolectomy about acute perforated typhlitis, two post-operative fistulae about clinical feature of pseudo-appendicitis. A study was undertaken on 183 patients; 160 patients complained of chronic in right iliac fossa, 23 of acute or subacute pain. Out of the 160 chronic patients, treated by metronidazole did not show symptoms anymore. Out of the 23 acute patients, 14 were cured thanks to the amebicide test-treatment and the 9 others showed during surgical intervention: 4 phlegmonous appendicitis, 3 appendicitis with inflammation of the mucous membrane, 2 appendicitis with abscess. In the acute cases, the duration of the therapeutic test was 10 ho. In the operated chronic cases (37 out of 160), histology substantiated surgery in revealing typical lesions of chronic appendicitis sometimes associated to anatomical deformity such as diverticulum. The authors strongly suggest such a test-treatment by metronidazole. It is well accepted and has enabled to get rid of post-operative morbidity of appendicectomy in tropical milieu.