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Overview

Appendicitis is the medical term given for inflammation or infection of the appendix, a small pouch that is attached to and hangs from the colon (large intestine).

The exact role of the appendix is not clearly understood but the theory is that it may be a regressing organ from our evolutionary past.

Other roles that the appendix may play include harbouring beneficial bacteria for improved gut health and functioning, or it may be involved in the immune system or fetal development.

Inflammation of the Appendix

Appendicitis is one of the most common causes of right-sided lower abdominal pain and if the inflammation is severe enough, the appendix may tear and leak bacteria into the abdominal cavity. This can result in peritonitis which is a dangerous infection of the tissue that lines the inner wall of the abdomen and which covers most of the abdominal organs.

The signs and symptoms of appendicitis may include:

  • Sudden pain experienced in the lower right side of the abdomen.
  • Decreased appetite.
  • Nausea and vomiting.
  • Low-grade fever.
  • Pain shifting from the right lower abdomen to the central abdomen.

Surgical Management

When a patient presents with signs and symptoms of appendicitis, the most common way for the condition to be managed is by surgically removing the infected tissue through a laparoscopic (keyhole) procedure where small incisions are made over the skin and slender instruments are used to perform the surgery.

If the inflammation is complicated, then a slightly larger incision is made over the lower right side of the abdomen and the appendix is removed. 

In cases where the appendix has ruptured, the management will entail performing a laparotomy where a large incision is made to gain access to as much of the abdomen as possible so that the peritoneum can be cleaned properly from the bacteria and fecal matter that would have spilled in the abdominal cavity after rupturing of the appendix.

The Role of Antibiotic in Appendicitis

Four randomized trials were performed by Nottingham University Hospitals in England and the following findings were made:

  • In 63 percent of cases, appendicitis was managed successfully with intravenous antibiotics alone.
  • Those who received antibiotics to manage the appendicitis were 39 percent less likely to develop complications such as those who underwent surgery.
  • Around 20 percent of patients who were managed with antibiotics had a return of their pain or other symptoms associated with appendicitis and needed to return back to the hospital with some of them having developed serious infections. 
As can be seen here, there are cases of appendicitis that can be managed effectively enough with antibiotics. With that being said, there are patients who end up coming back with even worse infections and they ultimately end up being operated.

Considerations 

The researchers of the mentioned studies state that physicians would need to determine simple but solid ways to identify which patients with appendicitis would be candidates for antibiotic therapy.

For patients who are elderly, have other health-related issues, and those who are at risk for developing peritonitis, surgery is adjudged as being a safer option. 

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