Appendicitis

A recent article in the British Medical Journal delivered the surprising news that not every case of appendicitis requires surgery. The authors followed 900 patients and found that patients treated with antibiotics had the same rate of complications versus good outcomes.

Early appendectomy has been the norm when the diagnosis of appendicitis is suspected or confirmed at admission in the belief that this may prevent complications such as perforation or peritonitis. This practice stems from the belief that appendicitis is a progressive disease and any delay in treatment increases the risk of complications. Increased diagnostic accuracy with CT scans and the better patient tolerance of laparoscopic surgery has reduced the threshold for surgery for appendicitis that may have resolved spontaneously. Initial use of antibiotics to treat appendicitis may delay an appendectomy in patients who are not improving, but this delay does not lead to an increased risk of complications. The overall risk of complications is lower, as appendectomy is avoided in two-thirds of the patients.

Starting antibiotics when the diagnosis of uncomplicated acute appendicitis is made, with reassessment of the patient, will prevent the need for most appendectomies. Oral antibiotics can be continued after discharge, allowing potentially shorter hospital stays.

This information is interesting, but preliminary and needs to be more widely tested. Appendicitis is not a do it yourself item! The usual symptoms of appendicitis include severe pain the right lower part of the abdomen, often starting near the belly button and then moving to the right lower side, loss of appetite, nausea and vomiting and fever. These symptoms warrant a prompt medical evaluation.