This year, approximately 700,000 appendicectomies will be performed in North America. And although the modest appendix does not receive attention associated with other problems, each year, nearly 3,000 people will die of appendicitis. But do all cases require surgery?
We have come a long way since the French surgeon Guillaume Dupuytren ridiculed the idea that the appendix could be the cause of the infection. Later, Henry Sands, a surgeon from New York, simply stitched a hole in an annex! It is also hard to believe that another surgeon has just corrected the weaknesses of the appendix! If these patients survived, it is the Almighty who saved them.
The appendix is a finger-shaped tube approximately four inches long and located in the lower right portion of the abdomen. These are usually bacteria, viruses, parasites or fungi that block the opening of the appendix, causing infection and pain.
Today, once the diagnosis is made, the reference treatment is the immediate surgical removal of the appendix. For years, this involved abdominal surgery. Now, removal is often done by laparoscopic surgery. But whatever decision is made, it is essential to remove the appendix before it breaks, which would result in peritonitis and a possible death.
Some studies show that surgery may not always be required for all cases of appendicitis. For example, a study conducted in Finland between 2009 and 2012 analyzed cases of uncomplicated appendicitis. These involved patients without perforation, without formation of abscesses and inflammation located in the appendix. Some have been successfully treated with antibiotics and have not required surgery during a one year follow-up period. Other, where the antibiotics failed, required surgery but did not have significant complications because of the delay.
A subsequent study in 2018 concluded that six out of ten patients treated with antibiotics for uncomplicated acute appendicitis remained free of the disease for five years. Other studies have also concluded that the use of antibiotics is a feasible alternative to surgery.
I would add other important considerations. Where you are when appendicitis attacks are important. Years ago, I was a young surgeon aboard a ship carrying 800 displaced people from Germany to Canada. There was no anesthetist on board. The option of antibiotics would have been an easy decision if I had met a passenger with appendicitis.
But even if a surgeon is in a well equipped hospital, the decision is never easy. Every surgeon knows that the abdomen can hold a surprise package that can result in embarrassing results. So, what he or she believes to be a docile appendix may be about to break down with disastrous consequences. Or the diagnosis may be a twisted gangrenous ovarian cyst or a cancerous intestine.
It has been almost 300 years since Claudius Amyand removed the first annex of St. George's Hospital in London. Now, every year, about 700,000 North Americans will develop appendicitis, 13,000 people a week, 1,836 a day, 77 at the hour or one per minute.
It is always a tragedy to die of a preventable disease. Today, one in every thousand people dies because of an imperforated appendage. The number is five on a thousand if punched.
So, do not make those mistakes. If you develop abdominal pain, do not self-diagnose and do not assume that you are too absorbed at dinner. Do not think the pain is due to constipation and take a laxative. It is a bad decision if the pain is due to intestinal obstruction. And do not decide to eat a meal.
The logical decision is to get prompt medical advice. When sudden pain strikes the right lower abdomen, consult your doctor and if the pain is severe, go to the hospital emergency room.
Remember, "If you decide to heal yourself, you will have a mad for a patient!
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NOTE FROM THE EDITOR: The column does not constitute medical advice and is not intended to diagnose, treat, prevent or cure any disease. Please contact your doctor. The information provided is for informational purposes only and only for their author.