Suggest Treatment For Perforated Appendix

Posted on Mon, 30 Jan 2017

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 30 Jan 2017 Answered on

Wed, 22 Feb 2017 Last reviewed on

Question : DIAGNOSED WITH POSS RUPTURED APPENDIX. TREATED WITH IV ABX FOR APPROX 1 WEEK. NO FURTHER PAIN OR FEVERS, TOLERATING REGULAR DIET. MD STATED HE FELT A "HARD" AREA AT THE SITE OF THE APPENDIX WHEN HE PAPLAPTED. THERE WAS NO PAIN, AND HAS NOT BEEN ANY FOR ABOUT 4 DAYS. DID REPEAT CT SCAN TODAY, NO RESULTS YET BUT IT WAS SORT OF DISCUSSED THAT THE APPENDIX MAY BE LEANING ON OR FUSED TO THE COLON, AND THE PERCEPTION IS THAT MAY SURGERY WILL BE REQUIRED. IF THE RUPTURED APPENDIX JUST OCCURED, HOW LONG DOES IT TAKE FOR AN APPENDIX TO BE LEANING ON OR FUSED TO THE COLON?
IS SURGERY ABSOLUTELY NECESSARY AND CAN THIS BE DONE LAPAROSCOPICALLY? WHAT ARE THE CONSEQUENCES OF REFUSING SURGERY? AM NOW ASYMPTOMATIC AND DO NOT WANT TO GO THROUGH THIS. BY THE WAY, HAD A COLONOSCOPY ALSO THIS ADMISSION WHICH WAS ABSOLUTLEY NEGATIVE.

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
as explained in details.

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Male/68 - admitted with possible perforated appendix with hard area - on antibiotics - tolerating food - asymptomatic - wants to know further.
To answer your queries:
- It takes about 3-6 weeks for the things to become normal.
- As per the history you have provided, this looks to be perforated appendix with appendicular mass formation. It takes about 3 to 6 weeks for resolution - surgery is performed as a planned case in such a situation as it is very difficult and can be messy surgery due to either adhesion and/or friability of the tissue is increased.
- Hence if you are improving symptomatically and signs wise, if there is no formation of appendicular abscess, the conservative management has to be continued and surgery to be planned preferably after 6 weeks to avoid any complications.
- Surgery is absolutely necessary as you can have further attack any time.
- Surely it can be done by Laparoscopy.
- Refusing surgery: If there is appendicular abscess formation, immediate surgery will be required to save life. If you respond well to the conservative management as you are now as per the history you have provided, interval appendectomy should be done so as to avoid the further attack.

I hope this answers your query. Please feel free to ask for further relevant queries if you feel that there is a gap of communication.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar