You Ask , They Answer confirmed on CT scan ) can be safely and successfully treated with antibiotics alone , although other studies have suggested that 40 percent of conservatively treated acute appendicitis will require surgery within five years , mainly for recurrent appendicitis which is more likely in the presence of fecoliths .
All patients with appendicitis should be examined and counseled by a surgeon to determine their preference in a shared decision-making process . It should be noted that antibiotic treatment alone is not recommended for children under 12 years , pregnant patients , elderly patients over 60 years , and patients with severe signs of infection , or who are immunocompromised ( e . g ., transplant or cancer patients ). In addition , it should be pointed out that , although there may be cost savings to be gained with non-operative management , this should not be the main consideration in making the choice .
Q
: What ’ s appendicitis and why does it develop ?
A
: Appendicitis is inflammation of the appendix which usually develops when the lumen of the appendix is blocked . This may be due to a solid ball of fecal material called a fecolith present , swollen gut lining or lymphatic tissue caused by bacterial or viral infections , gut parasites , or a mass , for example from cancer . The appendix then becomes distended and may progress to infection , pus formation , perforation , and gangrene .
Q
: What are the telltale signs that require a medical consultation ?
A
: Early symptoms may include fever , nausea , vomiting , constipation or diarrhoea , and dull pain above or around the belly button . Medical consultation is required if the pain becomes sharply localised to the right lower and / or lower abdomen after several hours , especially if the pain is aggravated by coughing or walking .
Q
: What ’ s the right choice for individual patients between surgery and antibiotics ?
A
: Recent studies suggest that as many as 70 percent of patients with a first presentation of uncomplicated appendicitis ( not perforated and with no abscess , usually
Patients might choose surgery to reduce the risk of : 1 . readmission to hospital 2 . needing a drain put into the abdomen or pelvis to remove pus 3 . recurrent appendicitis 4 . missing a cancer
They might choose antibiotics to reduce the risk of : 1 . surgery 2 . missing more days of work for themselves and their caregivers in the short term
To put this in perspective , it might be a reasonable choice for a patient to have antibiotic treatment if he or she is hosting a wedding dinner at the upcoming weekend , or if the risk of surgery is advised to be high because of active COVID infection , but it would be wise to opt for surgery if the plan is to make a long trip to a rural area in the next year .
Q
: Can people prevent or lower the risk of appendicitis ?
A
: There is no proven way to prevent or lower the risk of appendicitis , but having a regular bowel habit and taking a high fibre diet may be helpful .
Dr Richard Sim
Dr Richard Sim is a Senior Consultant general and colorectal surgeon at Farrer Park Hospital . He was President of the Society of Colorectal Surgeons ( Singapore ) and he ’ s currently Treasurer of the International Society for Pelvic Floor Disorders .
14 ISSUE 5 | 2022 GlobalHealthAsiaPacific . com