DEAR DR. ROACH:
I went to the hospital and was diagnosed with appendicitis. I’ve been sick for three days. My surgeon said that although the CT scan showed a ruptured appendix, he wants me to take antibiotics for a week or so, and then come back in six to eight weeks for surgery.
I don’t want to wait! Wouldn’t it be better to get this done now? I’m in pain, and I’m worried I will get a very severe infection. Why do I need to wait? Why don’t they operate? I always thought that when you have appendicitis, they operate right away. — D.S.
ANSWER:
The optimal treatment of acute complicated appendicitis is changing. In cases like yours, where the body has partially or completely walled off the infection, giving antibiotics and waiting for the inflammation to reduce make the operation safer. Of course, if a person is unstable, or if the perforation is free, that requires an emergency surgery. Observation by a skilled surgeon is still necessary for a period of time on antibiotics to make sure the person is not in need of urgent surgery.
I spoke with one of my surgical colleagues who noted that operating immediately in a case like yours may require removal of part of the colon, because there is so much inflammation that extensive surgical dissection is required. Giving the body a chance to wall off the infection and the antibiotics time to kill the bacteria means that when they do the surgery later, it is easy and with less risk of complication.
I understand you want the problem solved right away, but you are likely to have a better long-term outcome if you postpone the surgery.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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