Management

Medical Therapy

Antibiotics have an important role in the treatment of patients with this condition. Antibiotics considered for patients with appendicitis must offer full aerobic and anaerobic coverage. Duration of the administration is closely related to the stage of appendicitis at the time of the diagnosis, considering either intraoperative findings or postoperative evolution. When the patient becomes afebrile and the WBC count normalizes, antibiotic treatment may be stopped. Cefotetan and cefoxitin seem to be the best choices of antibiotics.

Pain from appendicitis can be severe. Strong pain medications (i.e., narcotic pain medications) are recommended for pain management prior to surgery. Morphine is generally the standard of care in adults and children in the treatment of pain from appendicitis prior to surgery.

Surgical Therapy

Appendectomy remains the only curative treatment of appendicitis. The surgical procedure for the removal of the appendix is called an appendicectomy (also known as an appendectomy). Often now the operation can be performed via a laparoscopic approach, or via three small incisions with a camera to visualize the area of interest in the abdomen. If the findings reveal suppurative appendicitis with complications such as rupture, abscess, adhesions, etc., conversion to open laparotomy may be necessary. An open laparotomy incision if required most often centers on the area of maximum tenderness, McBurney's point, in the right lower quadrant. A transverse or a gridiron diagonal incision is used most commonly.

Laparoscopy has some advantages, including decreased postoperative pain, better aesthetic result, a shorter time to return to usual activities, and lower incidence of wound infections or dehiscence. This procedure is cost effective but may require more operative time compared with open appendectomy.

Follow-up

After hospital discharge, patients must have a light diet and limit their physical activity for a period of 2-6 weeks based on the surgical approach (ie, laparoscopic, open appendectomy). The patient should be evaluated by the surgeon in the clinic to determine improvement and to detect any possible complications.