Appendicitis Treatment Options

What is Appendicitis?

Appendicitis is a common infection of the appendix, a finger-sized tube that is attached to the large intestine. The infection causes pain and may make you feel sick. Doctors don’t know why it develops, but everyone who has an appendix is at risk for appendicitis.

How Is Appendicitis Treated?

Most patients in the United States have surgery called an appendectomy to take out the infected appendix. But results from six European studies show that medicines called antibiotics can treat the infection without surgery in some patients.

In these studies, patients who were successfully treated with antibiotics were contacted a year after their first hospital visit. About 3 out of 4 did not have any more problems with their appendix. The 1 in 4 who had surgery after trying antibiotics had similar results to patients who had the surgery right away.

No one knows for sure which treatment is better: surgery to take out the appendix, or medicine to treat the infection. We are doing this study to try to figure that out.

Appendectomy

Most people who have appendicitis have surgery to take out the appendix. This surgery is called an appendectomy.

Before surgery, the patient is given medicines called anesthesia. These medicines make them sleep and keep them from feeling pain during surgery.

Surgery may be done with a camera and small instruments using three or four tiny incisions, or cuts, on the patient’s belly. This is called laparoscopic surgery. Surgery may also be done with a single, larger incision. This is called open surgery.

During surgery, the appendix is removed from the patient’s body. Then the incisions are closed with staples or stitches.

The surgery usually takes about an hour. Afterward the patient may feel groggy from the anesthesia for a few hours. 

Most patients recover quickly from surgery and go home by the next day. Some stay in the hospital for an extra day. 

Most patients will:

  • Eat and drink shortly after surgery
  • Be sent home with pain medicine to take as needed
  • Return to normal activities after a week or so

What Are The Benefits?

Surgery for appendicitis cures the problem. Patients do not get appendicitis again after the appendix is removed.  

What Are The Risks?

About 1 out of 10 patients has a problem after an appendectomy. Most of these problems are minor, such as a skin infection where the incisions were made.

Serious problems may include infections or bleeding inside the belly, or leaking from the intestine where the appendix was attached. These problems do not happen very often. If they do occur, another surgery might be needed to fix them.

Antibiotics

Antibiotics are medicines that fight infection. If appendicitis is treated with antibiotics while a patient is in the emergency room, they might be able to go home the same day. Or, they might stay in the hospital for an extra day or two. How soon the patient goes home depends on how they respond to the medicine.

First, antibiotics are given into the vein through a small, flexible plastic tube. While the patient is getting antibiotics, they may also get medicines to treat pain and nausea, if they need them. Most patients can eat and drink while taking antibiotics.

Once the patient goes home, they will have to keep taking antibiotics as a pill for a total of 10 days, even if they feel better. They will also be sent home with pain medicine to take as needed.

What Are The Benefits?

If antibiotics work, the patient will not need to have surgery. They may be able to get back to work or school faster and have less pain than if they have surgery.

Results from six studies tell us that antibiotics are a safe way to treat appendicitis. In these studies, patients who were successfully treated with antibiotics were contacted 1 year after their first hospital visit. About 3 out of 4 patients did not have any more problems with their appendix.

What Are The Risks?

Antibiotics, although usually safe, can also cause side effects such as skin rashes and diarrhea which are rarely serious.

There is also a 1 out of 4 chance that antibiotics will not cure the appendicitis—or that appendicitis may come back in the future—even if it is successfully treated with antibiotics the first time.

If antibiotics do not cure the patient’s appendicitis, they may need to have surgery at some point.