How is appendicitis treated?

Once a diagnosis of appendicitis is made, an appendectomy usually is performed. Antibiotics almost always are begun prior to surgery and as soon as appendicitis is suspected.

There is a small group of patients in whom the inflammation and infection of appendicitis remain mild and localized to a small area. The body is able not only to contain the inflammation and infection but to resolve it as well. These patients usually are not very ill and improve during several days of observation. This type of appendicitis is referred to as "confined appendicitis" and may be treated with antibiotics alone. The appendix may or may not be removed at a later time.

On occasion, a person may not see their doctor until appendicitis with rupture has been present for many days or even weeks. In this situation, an abscess usually has formed, and the appendiceal perforation may have closed over. If the abscess is small, it initially can be treated with antibiotics; however, the abscess usually requires drainage. A drain (a small plastic or rubber tube) usually is inserted through the skin and into the abscess with the aid of an ultrasound or CT scan that can determine the exact location of the abscess. The drain allows pus to flow from the abscess out of the body. The appendix may be removed several weeks or months after the abscess has resolved. This is called an interval appendectomy and is done to prevent a second attack of appendicitis.

What is new about appendicitis?

Recently it has been hypothesized that some episodes of appendicitis-like
symptoms, especially recurrent symptoms, may be due to an increased sensitivity
of the intestine and appendix from a prior episode of inflammation. That is,
the recurrent symptoms are not due to recurrent episodes of inflammation.
Rather, prior inflammation has made the nerves of the intestines and appendix
or the central nervous system that innervate them more sensitive to normal
stimuli, that is, with stimuli other than inflammation. This will be a difficult,
if not impossible, hypothesis to confirm.

Appendectomy At A Glance

• The appendix is a small, worm-like appendage attached to the colon.
  
• Appendicitis occurs when bacteria invade and infect the wall of the appendix.
• The most common complications of appendicitis are abscess and peritonitis.
• The most common manifestations of appendicitis are pain, fever, and abdominal tenderness.
• Appendicitis usually is suspected on the basis of a patient's history and physical examination; however, a white blood cell count, urinalysis, abdominal x-ray, barium enema, ultrasonography, CT, and laparoscopy also may be helpful in diagnosis.
• Due to the varying size and location of the appendix and the proximity of other organs to the appendix, it may be difficult to differentiate appendicitis from other abdominal and pelvic diseases.
• The treatment for appendicitis usually is antibiotics and appendectomy (surgery to remove the appendix).
• Complications of appendectomy include wound infection and abscess.