Introduction:
The appendix is a small finger-shaped pouch measuring about 3.94 to 4.72 inches (10 to 12 centimeters) and is on the right side of the abdomen projecting from the colon (a part of the large intestine). In young children, it plays an important role in immunity. As the child grows, other body parts take up the immune function, leaving the appendix with no function. Sometimes the appendix may get infected and inflamed. The infected appendix may rupture and spread the infection to other body parts. Such conditions must be treated in an emergency to prevent fatal conditions.
What Are the Symptoms of Appendicitis?
Everyone has an appendix, but appendicitis is usually seen in people between 10 to 30 years old. The symptoms include
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Instantaneous pain that starts from the right side of the stomach and slowly radiates toward the belly button region.
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Pain intensity increases during coughing or physical movements.
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The patient can experience gas formation (flatulence) and mild fevers.
What Are the Complications of Appendicitis?
In Appendicitis, if left unaddressed, the appendix gets more inflamed, leading to severe pain and rupture would take place. The complications include:
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Peritonitis: This is a life-threatening condition, and it should be treated as soon as possible. Increased pressure causes rupture of the appendix, leading to the spread of infection into the abdominal cavity (peritonitis). Quick surgery must be performed, and the appendix must be removed, followed by cleaning of the infection from the entire abdominal cavity. Proper care must be taken during the surgery to clean and clear the infection from the abdomen.
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Abscess Formation: Infection in the appendix leads to pus formation; when this happens, the doctor places tubes into the abdomen to drain the pus from the appendix. This usually takes time (one or two weeks); during this time, doctors prescribe antibiotic regimens. Once when the abscess is completely cleared off, the doctor performs the surgery and removes the appendix. In a few emergency cases, drainage of pus is done immediately, followed by surgery on the same day.
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Septicemia: In general, septicemia is known as blood poisoning by bacteria. When the appendix ruptures, the infection enters the bloodstream and from there, the infection is carried to different parts of the body, affecting vital organs. This can lead to septic shock and would result in the death of the patient. If this happens patients must be placed on a high dosage of antibiotics, and immediate surgery (appendectomy) must be carried out to prevent the worsening of the condition.
Can an Individual Have Appendicitis Twice?
It is rare, but an individual can experience appendicitis twice. The condition is managed by surgical removal of the appendix. In some cases, people have residual appendix leading to the recurrence of appendicitis. The factors that can lead to recurrent episodes of appendicitis are as follows:
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If a small tissue of the appendix is left behind even after the surgical procedure.
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Incomplete removal of inflamed appendix.
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Anatomical variation in the appendix.
How to Treat Appendicitis?
Most cases of appendicitis require surgical removal of the appendix, but depending on the severity, antibiotics are also advised in certain conditions.
1. Appendectomy: Surgical removal of the appendix is known as appendectomy. In most of the cases, appendectomy is performed laparoscopically. In this procedure, two to three abdominal cuts are made, and from one of the cuts, a small thin tube is inserted into the abdominal cavity. The tube at one end has a camera, and at the other end is connected to the monitor. Pictures of the inflamed appendix are captured and displayed on the screen, and then from the other abdominal cut; the doctor inserts a surgical tool for the removal of the appendix.
This minimally invasive technique helps in faster recovery time and reduces hospital stays. Healing seems to be faster, and the patient can return to daily activities within a short period.
However, not every case can be treated by laparoscopic surgery. The doctor performs open surgery if the appendix ruptures and the infection spreads into the abdominal cavity. In this procedure, a large cut is made onto the right side of the abdomen where the surgeon can access the abdominal cavity directly, and this allows the surgeon to remove the appendix and clean the entire abdominal cavity that is contaminated with pus.
2. Antibiotics: In acute appendicitis, antibiotics are the treatment choice. Mild cases of appendicitis can be treated with antibiotics. It is the appendicitis treatment without surgery. However, during antibiotic therapy, close monitoring of the patient is required. Despite antibiotic usage, if still, the symptoms persist, then the patients are advised for surgery.
Some doctors prefer to use antibiotics before the surgery. Intravenous administration of antibiotics is done before the surgery to prevent the spread of infection and reduce post-operative complications. The common antibiotics used for treating appendicitis are as follows:
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Cefoxitin.
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Metronidazole or Ceftriaxone.
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Ertapenem.
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Piperacillin-Tazobactam.
Advising antibiotics during appendicitis is a critical decision, and many factors must be taken into account before prescribing. The factors that need to be considered are:
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Age of the patient (adults or children).
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Complications of appendicitis (whether it is ruptured or inflamed).
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Postponing the surgery (due to unavoidable health conditions, such as cancer treatments).
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Percutaneous drainage (it is an image-directed drainage technique that is done through a minimally invasive technique). In most cases, percutaneous drainage gives better results than conventional appendectomy.
Which Is the Best Option Antibiotics or Appendectomy for Appendicitis?
Antibiotics as an appendicitis treatment without surgery. It remains to be a better option for some cases, but this does not provide beneficial effects for all cases. Surgical removal of the appendix is considered the gold standard in treating appendicitis, but a choice to use antibiotics remains an alternate way to cure appendicitis. Depending upon the severity, the doctor decides the treatment plan for treating appendicitis. But the preference of the patient must also be taken into account, like certain patients want to have immediate surgery, thinking that the appendix is an organ with no function and wants to get cured permanently. Patients who fear surgery opt for antibiotics, assuming that if antibiotics do not work, they will undergo surgery.
Conclusion:
Appendectomy remains to be the first choice of treatment in cases of appendicitis. But not all cases of appendicitis require appendectomy, antibiotic usage is also advised in certain cases. Sometimes antibiotics act as a bridge to surgery. Depending upon the symptoms and onset (acute or chronic) of appendicitis, it is the doctor's choice and the patient's preference to opt for appendectomy or antibiotics.
