Updated: January 10, 2018
Appendicitis is inflammation of the appendix. It is a medical emergency that requires prompt surgery to remove the appendix. An inflamed appendix will eventually burst or perforate resulting in spilling infectious materials into the abdominal cavity if left untreated.
Treatment for appendicitis varies depending on the details of your case once a diagnosis of appendicitis is made. When the inflammation and infection of appendicitis remain mild and localized to a small area, treatment plan might only involve antibiotics and a liquid diet until your symptoms resolve.
This type of appendicitis is referred to as confined appendicitis. If a rupture has been present for many days or even weeks without treatment, an abscess will be formed and the appendiceal perforation may have closed over. If the abscess is small, it initially can be treated with antibiotics and later requires drainage. In this procedure a drain is inserted through the skin and into the abscess. With the help of an ultrasound or CT scan the exact location of the abscess can be determined. 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 which is called an interval appendectomy and is done to prevent a second attack of appendicitis.
Surgery may be required immediately if you have a ruptured abscess or appendix. Surgery to remove the appendix is known as an appendectomy. This procedure can be done as open surgery or through a laparoscopy. Laparoscopy is less invasive, making the recovery time shorter. However, open surgery may be necessary if you have an abscess or peritonitis.
This procedure can be done either laparoscopically or through traditional abdominal surgery. During a traditional abdominal surgery two to three inches of incision is made through the skin and the layers of the abdominal wall over the area of the appendix. The surgeon looks in to the abdomen to examine the area around the appendix to ensure the presence of any additional problem. The appendix is then removed by cutting the appendix from its mesenteric attachment to the colon, cutting the appendix from the colon and sewing over the hole in the colon. The drain allows pus to flow from the abscess out of the body during drainage if an abscess is present. The abdominal incision will be closed after that.
In case of laparoscopy a small fiber optic tube with a camera is inserted into the abdomen through a small incision made on the abdominal wall. It allows a direct view of the appendix as well as other abdominal and pelvic organs. The inflamed appendix can be removed with the laparoscope if appendicitis is found.
The benefits of the laparoscopic technique include less post-operative pain and speed recovery. Another advantage of laparoscopy is to to make a clear diagnosis. Laparoscopy is especially helpful for menstruating women in whom a rupture of an ovarian cyst may be confused with appendicitis.
After surgery the patient is generally sent home from the hospital surgery in one or two days if If the appendix is not perforated at the time of surgery. If peritonitis has occurred, the hospital stay is prolonged. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any abscess.
The most common complication of appendectomy is infection of the wound arises mostly from surgery. There will be redness and some tenderness over the incision in case of mild infection. Moderate infection requires only antibiotics where as severe infection requires antibiotics and surgical treatment.
Sometimes the inflammation and infection of appendicitis are so severe that the surgeon will not close the incision at the end of the surgery because of concern that the wound is already infected. In such cases, the infection can be treated with antibiotic therapy to reduce the risk of infection to occur within the incision. The skin closing is postponed for several days till the infection subside with antibiotic therapy. The risk of wound infections are less with laparoscopic surgery. Another complication of appendectomy is an abscess, a collection of pus in the area of the appendix or pelvis.
Removing the appendix has no major, long-term health problems. There is a little risk of developing some diseases, such as Crohn's disease which is very rare.