Some aspects of appendicitis

ABSTRACT

(1) Make a confident diagnosis on the acute abdomen before giving any antibiotic. (2) When in doubt at the first examination re-examine the patient six to twelve hours later and do not give the patient any drug in the interval. (3) Abdominal pain which disappears in six hours is not of inflammatory origin. (4) The treatment of acute appendicitis is appendicectomy, not antibiotics. (5) Antibiotics reduce morbidity and mortality only if given as part of planned treatment for diagnosed pathology. (6) A solid inflammatory appendix mass can be removed. (7) An appendix abscess should be drained. If the appendix presents itself it may be removed at the time or safely left until later. If the appendix is seen of if the patient is ill, simple drainage is best, followed in six to twelve weeks by an interval appendicectomy. This avoids complications due to surgery on an oedematous caecum such as fistula or peritonitis. (8) The diagnosis of acute appendicitis is not always easy, as it may mimic other diseases, so it should never be forgotten (AU)