Uncomplicated appendicitis may not require surgery

Dear Doctors: I had a pain on the right side of my abdomen. A CT scan found a perforated appendix with an abscess. I was treated with IV antibiotics, and now I am feeling fine. Do I need to have my appendix taken out? My doctor says, in cases like mine, people have problems again 30% of the time.

Dear Reader: The appendix is a thin tubelike pouch that extends from the colon on the lower right side of the abdomen. It was previously thought to be a vestigial organ with no purpose. Newer research suggests a link to immune system function and the gut microbiome. If something blocks the opening to the appendix, it closes. This prevents the organ from draining and restricts blood flow. A blockage sets the stage for inflammation, infection and internal pressure that can cause the organ to get a small hole or rupture.

A ruptured appendix is a medical emergency. The large break in the appendix wall allows the build-up of infectious materials to spill into and contaminate the abdominal cavity. This can quickly escalate to a life-threatening infection known as peritonitis. Surgery is the primary treatment for a ruptured appendix. The appendix must be removed, and the abdominal cavity must be cleaned out. However, in cases that are less severe, new approaches are emerging.

Sometimes, as in your own case, a CT scan will show that, while the organ is inflamed, has an abscess or is perforated, it is not in danger of bursting. This is a condition known as uncomplicated appendicitis. In these cases, rather than immediate surgery to remove the organ, initial treatment with antibiotics can become an option. Patients who wish to avoid the risks associated with surgery, the cost of an appendectomy or the recovery sometimes choose this approach.

It sounds like you don’t have the fever, pain or nausea that signal infection. It appears your doctors consider you a candidate for ongoing nonsurgical management. Unlike an appendectomy, which removes the organ, this is not a cure. This is the first step of an approach known as watchful waiting. First, the condition is treated with antibiotics. Then your symptoms are actively monitored. The option of surgery is still available if necessary.

In 2021, a study on uncomplicated appendicitis was published in the New England Journal of Medicine. It analyzed health data from 1,552 adults in 25 United States medical centers with this condition. The researchers found that half of patients made it four years before needing surgery. One-third developed recurrent appendicitis and required surgery within three months. This study has influenced a shift to offering nonsurgical management to eligible patients.

The decision regarding surgery should be made with guidance from your own doctors. If you continue with nonsurgical treatment, it’s important to look out for symptoms of appendicitis. If you get any symptoms, let your doctor know immediately. Another round of antibiotics or surgery may be needed.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)