Now, even the "interval appendectomy" is becoming controversial a newer school of thought holds that some patients may do best with antibiotics alone, no operation at all. But research found that for a certain group of patients, it was better to wait. Smink said, surgeons would go in and operate on virtually all cases of appendicitis, whatever the level of inflammation. National Archives and Records Administration via Wikimedia Commons) (And by the way, even emergency appendectomies are done promptly but not with quite the urgency of old waiting several hours appears to do no harm.) A 1940s appendicitis poster (U.S. So the idea is to give the patient antibiotics to fight the infection, wait as the inflammation subsides and then do an "interval appendectomy," after the waiting interval. Smink said, and an appendectomy could end up turning into removal of part of the intestine and colon as well. An area rife with inflammation is hard for surgeons to work with, Dr. Still, why not just operate and get rid of the problem? It's not so simple. So a patient can end up with a pus-filled abscess outside the appendix, covered partially by the omentum. Smink said, is that a somewhat mobile layer of visceral fat called the omentum - nicknamed "the policeman of the abdomen" - could be drawn toward areas of inflammation to contain infection. Here's the good news for patients like Martha: The appendix is surrounded by other structures, mostly the intestine, and so, as she was told, the seepage can get "walled off." One theory, Dr.
But the fluid doesn't explode out like a splatting water balloon it seeps and oozes out as if the balloon had sprung a leak.) Smink explained: The appendix, which is about the size and shape of a pinky finger, gets very inflamed until, in one area, its muscular wall gets so thin that it breaks open, releasing the bacteria-laden fluid inside. (A brief tangent: I suddenly realized that I could not picture a "perforated appendix." Was it like a water balloon exploding? A cardboard box torn along its perforations? Dr. The appendix marked in red (Olek Remesz, Wikimedia) In the United States, perhaps 80 percent of appendicitis cases get to surgery before the organ ruptures. While "walking pneumonia," which is not a medical term, tends to be a milder form of the illness, there's nothing mild about appendicitis that has already reached the point that it has perforated the appendix. Smink, program director of the general surgery residency program at Brigham & Women's Hospital. Some people get "walking pneumonia." You have "walking appendicitis."īut I was gently corrected by Dr. Who knows? All I know is that these days, if the burst appendix doesn’t kill you, they wait until the infection goes away and then take the thing out laparoscopically, in a same-day turnaround operation. But I wonder if the water of the bath I took helped take the pressure off and slowed the infection. I have also read that heating pads and hot baths are not necessarily good for you when you have appendicitis. I am now on massive doses of the antibiotics Cipro and Flagyl, and staying away from alcohol. No, this is not the ultimate workaholism. And she's been working in the newsroom this week as usual, burst appendix and all.
Our case in point: WBUR's news director, Martha Little. Where once acute appendicitis meant an instant trip to the operating room, that call is now becoming somewhat more nuanced, and is likely to become still more refined in coming years. Appendectomies are the most common emergency operation that general surgeons perform - at a rate of more than a quarter of a million a year.īut medicine is ever-evolving, and the thinking on appendectomies has been changing in recent years. That's the popular image of appendicitis, and it does reflect reality. You've seen acute appendicitis on hospital shows: The patient hunched over in unbearable stomach pain, rushed to the operating room for life-saving surgery to remove the organ gone awry. If you experience symptoms of appendicitis, particularly sharp pain in the lower right area of your abdomen, get prompt medical care.Įnd of warning. Navy via Wikimedia Commons)įirst, the warning label for this story: A perforated appendix can kill you. An urgent laparoscopic appendectomy performed aboard the nuclear-powered aircraft carrier USS Enterprise (U.S. Twitter facebook Email This article is more than 9 years old.