What is the treatment for appendicitis?
You will be admitted to hospital if appendicitis is suspected.
The normal, established treatment of appendicitis is an operation to remove the inflamed appendix. The aim is to do this before it bursts (perforates), as a perforated appendix is a very serious condition. Antibiotics are sometimes used to delay surgery. Very recently it has been suggested that in carefully selected cases appendicitis might possibly be treated by antibiotics rather than with surgery.
Surgery for appendicitis
The inflamed appendix is found and cut off at the first part of the large bowel (large intestine) - the caecum. The hole this leaves in the caecum is stitched up to stop contents from the gut leaking out. Antibiotic medicine is given before surgery to reduce the risk of infection developing at the site of the operation.
Sometimes antibiotics are used to delay surgery until the appendicitis has calmed a little. This may make the surgery safer and reduces the risk that the appendix will burst at operation.
Removal of the appendix is one of the most commonly performed operations in the UK. This is usually a straightforward and successful operation needing just a short recovery. Surgery is commonly done by a keyhole operation, as the recovery is quicker compared to having an open operation. The keyhole operation is performed through three tiny cuts, the largest of which is only around 1.5 cm in size.
Sometimes keyhole surgery isn't recommended and open surgery on the tummy (abdomen) area is performed instead. This is likely to be needed if the appendix has already burst and caused a severe abdominal infection (peritonitis) or formed a lump called an appendix mass. It is also more likely if:
- You have had other abdominal surgery and have scarring.
- During the keyhole surgery a blood vessel is damaged by the instruments and needs repair.
- Your appendix is not situated in the usual place.
- You are pregnant.
There are usually no long-term complications after the operation. As with any operation, there is a small risk of complications from the operation itself and from the anaesthetic. However, if you don't have an operation, an inflamed appendix is likely to burst and cause peritonitis. This can be life-threatening. Untreated burst appendix with peritonitis has caused many deaths in history. The famous magician, Harry Houdini, used to invite members of the audience to punch him in the stomach to demonstrate his strong abdominal muscles. Unfortunately, someone did this when he was unprepared. Even more unhappily, he had appendicitis at the time. His appendix burst and this resulted in his death some hours later.
Treatment of an appendix mass
If an appendix mass has formed then surgeons sometimes suggest postponing surgery whilst they drain the mass and treat with antibiotics, before doing a full appendicectomy a few weeks later. This allows patients to have surgery when they are less unwell, and the surgery is less difficult, as the inflammation has started to settle.
How about antibiotics instead of surgery for appendicitis?
Studies have suggested that in some cases appendicitis can be treated with antibiotics alone, without the need for surgery. This removes the risks associated with surgery, and is successful in many simple cases. However, the appendicitis often returns (relapses) later, so this is not yet established or routine practice.
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