Appendicitis is the inflammation of the appendix, which is a tube-like organ that extends from the large intestine. According to theories, the appendix is a specialized organ that is capable of producing antibodies. However, experts suggest that the appendix has no definite function in the human body. Moreover, the removal of one's appendix does no harm to the body and does not lead to any impairment in the body's overall function.
What generally causes appendicitis?
The most common causes of appendicitis are either a stomach infection that might have reached the appendix or an obstruction, which might have entrapped harmful microorganisms, foreign bodies, stool, or cancerous growth in the appendix. In both cases, the appendix will become infected and inflamed.
Signs and Symptoms
There are many distinct symptoms of appendicitis. It normally presents itself with a dull pain around the navel, which gets sharp as it moves towards the lower right abdominal area. It is more concentrated at the area known as the "McBurney’s Point". The deep-seated pain is accompanied by loss of appetite, nausea, vomiting, severe stomach upset, low-grade fever, painful urination, severe cramps, and abdominal swelling.
These signs and symptoms are usually ignored and treated by home remedies. It is important to note that pain-relieving medications, laxatives, antacids, and heating pads can rupture an inflamed appendix. A ruptured appendix can lead to fatal complications such as peritonitis, sepsis, multiple organ failure, and even death.
Treatment and Considerations
In rare cases, appendicitis heals on its own with just antibiotics and a liquid diet. However, in most cases, surgery is the standard treatment, which involves the removal of the inflamed appendix. Let’s learn more information about the treatment options for appendicitis.
1) Treatment Without Surgery – Medicinal Treatment
This treatment is usually used in minor cases where the appendix is swollen but not ruptured. If the appendix is left untreated, the inflamed appendix may develop serious issues such as fluid formation or small holes in the appendix. If the inflamed appendix does not rupture but leaks instead, an abscess is formed. The leakage limits the infection to a small area. Although the infected area is small, it can still be dangerous. If your abscess has not ruptured, the doctor will treat the infection first by prescribing antibiotics. The abscess will then be drained by inserting a tube into the body. After the infection is treated, surgery may be followed to remove the infected appendix.
There are many controversies over the non-operative management of appendicitis. However, antibiotics play a crucial role in the treatment of acute appendicitis as they are considered to be highly efficient in providing full treatment coverage to anaerobic and aerobic bacteria. The duration for which the antibiotics should be taken is directly related to the stage of appendicitis at the time of medical consultation and diagnosis. Administration of antibiotics is also closely related to finding the diagnosis and complications that might occur after an appendectomy. It is recommended for the patient to undergo antibiotic therapy before the surgery until the patient’s WBC count gets back to normal or until the patient shows controlled symptoms. The best antibacterial agents for the treatment of appendicitis are cefoxitin and cefotetan.
2) Surgical Treatment (Appendectomy)
After treating your infection, the next step is to remove the inflamed appendix through the surgical procedure called "appendectomy". If your appendix has already ruptured, surgery needs to be done immediately. An appendectomy can be performed through an open surgery or a laparoscopic method.
Usually, the doctors prefer the laparoscopic method over open surgery because it has a shorter recovery period and the incisions heal faster with minimum pain and scarring. During the procedure, the surgeon makes a few small incisions in your abdomen to access your appendix. He then inserts a video camera and special surgical tools to remove your appendix. Since this method has a shorter recovery period, it is more preferred for people who are obese or the elderly.
However, every person may not be the right candidate for laparoscopic surgery. If you have an abscess or if your appendix has already ruptured and the infection has spread even further, an open surgery may be done. An open surgery allows the surgeon to clean your abdominal cavity, which is quite impossible using the laparoscopic method.
Management of Appendiceal Mass
Appendectomy is a curative treatment for appendicitis. However, managing appendiceal mass is also important in many cases. The treatment falls under the three categories:
- Small abscess or phlegmon: In this case, an interval appendectomy can be performed after the administration of intravenous antibiotics for 4-6 weeks.
- Well-defined large abscess: A percutaneous drainage using IV antibiotics is considered in this case. The patient is discharged with a catheter and interval appendectomy is performed after closing the fistula.
- Multi-compartment abscess: Early surgical drainage is performed before an appendectomy.
Antibiotic Therapy vs. Appendectomy for Uncomplicated Appendicitis Treatment
The process of antibiotic management as an alternative to surgery has not been proven and is controversial. According to research and studies, it has been noted that patients who were treated with only antibiotics showed recurrence of symptoms within a year and had to undergo appendectomy as a curative treatment. Only CT-diagnosed uncomplicated appendicitis can be managed by antibiotic treatment.
The researchers from the Nottingham University Hospitals in England compared antibiotics and surgery for uncomplicated appendicitis and compiled the following results:
- Appendicitis treated with antibiotics alone only have a 63 percent successful outcome.
- People who received antibiotics were 39 percent less likely to have developed complications such as peritonitis, perforated appendix, or infection around the incision as compared to those who had surgery.
- About 20 percent of those treated with antibiotics alone had recurring pain and other symptoms, which made them consult their doctor again. Some of these cases were of serious infections.
This research has urged for the necessity of a solid foundation to properly assess the patients for appendicitis treatment. It is quite important to determine whether they are the right fit for antibiotic therapy or for the surgery. However, it concluded that although antibiotics play a very crucial role in the treatment, especially if the infection is widespread, they still cannot be considered as a one-time solution for appendicitis. For older people who have other health problems, surgery may be a safer option.