Antibiotics may be option for appendicitis
DEAR DOCTOR: My older brother was experiencing abdominal pain and nausea, and when he went to his doctor, he was told he had a “hot” appendix. Instead of surgery, he was treated with antibiotics. Is this safe?
DEAR READER: Surgery has long been the go-to method of dealing with appendicitis. The first successful appendectomy was actually performed in London in 1735, to remove the perforated appendix of a young boy who had swallowed a pin. Since that time, surgical techniques have advanced to the point where, by the late 1990s, traditional open surgery had given way to the less invasive laparoscopic approach. Now, medicine is revisiting the idea of treating the existing infection in the appendix rather than pre-emptively removing the organ.
The appendix is a thin, tubular pouch, 2 to 4 inches long in adults, which descends from the colon on the lower right side of the abdomen. Since it has no obvious purpose, it has been the subject of scientific speculation pretty much from the moment it was first identified. However, according to the
most recent findings, the appendix is more complex and more important than was previously thought. Research shows that it’s the site of vital cellular activity during fetal development. In adults, it appears to have a role in immune function.
An inflamed or infected appendix is a medical emergency. That’s because, if left untreated, the buildup of infectious materials inside of it can cause it to become perforated or even burst. If that happens, the contents of the appendix will spill into the abdominal cavity, which can lead to serious complications, like peritonitis. In cases of a burst or perforated appendix, surgery is always the primary treatment. Not only does the appendix need to be removed, the abdominal cavity must be cleansed to prevent infection.
When the appendix is merely inflamed, though, and when CT scans confirm that the organ is not in danger of bursting, treating the existing infection with antibiotics becomes an option.
Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA.