Causes and treatment of appendicitis

Here's everything you need to know about appendicitis.

Appendicitis is the inflammation and swelling of the appendix, a small tube-like structure protruding from the large intestine. It occurs when the appendix gets blocked with stool or foreign particles passing through the intestine. Blockage may cause infection, which results in painful swelling of the appendix.

How soon should you get treated after the diagnosis?When does it indicate emergency?

Appendicitis is a medical emergency that requires prompt treatment. Delay between symptom onset and treatment may pose a risk of ruptured appendix [1]. The pain of appendicitis may get severe as the infection spreads. If not treated at the right time, the appendix may burst and release pus, infecting the surrounding areas (peritonitis), which can be life-threatening. Sometimes, a tender mass of pus (abscess) may form around the burst appendix. This prevents the infection from spreading and hence, is a less critical condition.

What are the treatment options for appendicitis?

Appendectomy or surgical removal of appendix remains the only curative treatment of appendicitis, but antibiotics do play an important role in the treatment. Broad spectrum antibiotics may be prescribed before surgery to prevent post-operative infection. The duration administrating antibiotics is closely related to the stage of appendicitis at the time of diagnosis. Painkillers are prescribed to help control pain after appendectomy.

Surgery: Appendectomy remains the standard treatment for acute appendicitis. It is generally considered safer to remove the appendix than run the risk of it rupturing. If pus (abscess) has formed around the burst appendix then it is drained and followed by delayed appendectomy 4-8 weeks later.

Appendectomy can be performed as open surgery or laparoscopic surgery. In an open surgery, a single cut of about 5 to 10 cm long is done in the lower right side of the abdomen to remove the appendix. This method is preferred when the appendix has ruptured or when there is an abscess. Laparoscopic surgery involves insertion of special surgical tools through few small abdominal cuts to remove the appendix. The procedure does not involve too much pain or scarring and the patient can have a speedy recovery with laparoscopic surgery.

Antibiotics: An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis i.e. appendicitis sans ruptured appendix and appendix with pus-filled abscesses [2]. Nonsurgical treatment is also used when immediate surgery is not accessible or when there is temporarily a high-risk involved in operating the appendix.

Uncomplicated appendicitis may be management with antibiotics usually administered intravenously first, then orally. Pus-filled appendix is managed with surgical pus drainage. These procedures are followed by delayed appendectomy 4-8 weeks later. In some cases treatment of acute appendicitis with antibiotics may eliminate the need for surgery. In a study conducted on 900 patients hospitalised with uncomplicated appendicitis, all symptoms of appendicitis disappeared, without relapse or rehospitalisation during the first month, in 78% of patients in the antibiotic group. After one year of follow-up, 63% of patients treated with antibiotics were asymptomatic and had no complications or recurrences.[3]

Are there any alternative remedies?

According to a study, acupuncture can discernibly lessen pain and reduce the underlying inflammation in children with acute appendicitis. A modest and noticeable drop in one of the inflammatory biomarkers (white blood cell count) has been observed with this therapy, suggesting that the effectiveness of acupuncture may have a bio-physiological basis.

What should you do if you experience stomach pain after the treatment?

For a few days after the surgery, some pain and bruising is present, which improves over time. Painkillers can help control the pain. But consult your doctor if you have high fever, increased pain and swelling and/or you notice any discharge from the operated site.

You may also like to read:

• Appendicitis early diagnosis and treatment is the key to fighting its complications
• Ultrasound safer than CT scans or X-rays to confirm or rule out appendicitis
• 15 causes of abdominal pain

References:

1. Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006 Mar;202(3):401-6. Epub 2006 Jan 18. PubMed PMID: 16500243.

2. Salminen P, Paajanen H, Rautio T, Nordstr m P, Aarnio M, Rantanen T, Tuominen R, Hurme S, Virtanen J, Mecklin JP, Sand J, Jartti A, Rinta-Kiikka I, Gr nroos JM. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015 Jun 16;313(23):2340-8. doi: 10.1001/jama.2015.6154. PubMed PMID: 26080338.

3. Antibiotic therapy for acute appendicitis in adults. Fewer immediate complications than with surgery, but more subsequent failures. Prescrire Int 2014 Jun;23(150):158-60. Review. PubMed PMID: 25121154.

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