Appendicitis

Acute appendicitis is the most common abdominal surgical emergency in the world. The appendix is a pouch that projects from the large intestine on the lower right side. The pain often starts near the navel and then moves to the right side. There is often nausea, vomiting, fever and chills. The standard treatment is immediate surgical removal; these days the surgery is most often done via a laparoscope (Band-Aid operation).  If not treated, an acutely inflamed appendix could burst and cause a life-threatening infection.

There are some trials that show that treating acute appendicitis with antibiotics alone is effective. The risk with this choice is a recurrent/relapsing infection or missing a hidden cancer. It is easy, even with sophisticated imaging, to underestimate the severity of disease.  Many medical centers have operating rooms ready to go twenty-four hours per day but it appears safe to wait twelve hours (the next morning) if the patient presents in the middle of the night. Antibiotics need to be started immediately in any case.

Thirteen to twenty percent of acute appendices will perforate (burst). The surgery may be delayed if the diagnosis of perforation is made initially. The patients are often sicker and delay of surgery allows stabilization and better antibiotic coverage.

Less than one percent of cases of acute appendicitis will show a cancer. The diagnosis may not be made until the pathologist reviews the specimen.

Severe abdominal pain, especially when accompanied by fever, chills, nausea and vomiting, requires prompt evaluation by a medical professional. Imaging and blood tests are almost always required. The emergency department might be the first and best place to seek care.