News: Avoid Unnecessary Childhood Surgery by Considering Antibiotics First for Uncomplicated Appendicitis

A new study confirms that antibiotics can prevent surgical intervention if your child's appendix becomes inflamed, potentially saving his or her life.

Attached to the large intestine, the appendix is a finger-shaped organ about three to four inches in length. When inflamed by infection or blockage, the appendix can significantly distend, until it eventually ruptures.

A common medical emergency, most people know someone who has had appendicitis, or have had it themselves. While the appendix can become inflamed at any age, appendicitis usually afflicts those between 10 and 30 years of age. Over 5% of Americans have appendicitis at some point in their lives, which can cause deadly infections if not treated promptly. Treatment is usually surgery, a sometimes-risky proposition on its own.

When my grandfather had appendicitis back in the '30s, he wasn't able to get medical help in time. Unfortunately, he died of peritonitis—the infection that follows a ruptured appendix—long before I had the chance to even meet him.

Treatment and knowledge of the appendix has evolved since then. Instead of being considered a leftover or vestigial organ, science is finding new value in the appendix as studies suggest it could be a reservoir for beneficial bacteria. So surgical removal of the appendix should be a last resort.

There are a couple of causes of an inflamed appendix, including:

• blockage or growths in the appendix
• tissue infection and enlargement
• inflammatory bowel disease
• injury or trauma to the appendix or abdomen

Symptoms of appendicitis can vary. One of the shifty things about appendicitis is that symptoms can come and go over time, change, or impersonate other illnesses. Common, clear symptoms include a sudden pain that begins around your belly button and eventually consolidates on your right lower side.

Less clear are symptoms that mimic a stomach bug, like loss of appetite, nausea, diarrhea, and a low fever. By the time you figure out that you, or your child, does not have a stomach bug, it is time to get to a doctor pronto.

While surgery is the gold-standard for treating appendicitis, surgery is invasive, costly, and not without risk. Still, appendectomy is the most common cause of emergency abdominal surgery in the US, with approximately 280,000 surgeries performed each year.

When my own appendix ruptured, a combination of quick medical care, general surgery, and antibiotics helped me avoid serious infection or worse.

In recent years, physicians have started to treat cases of non-ruptured, inflamed appendix with antibiotics, and a new study published in Pediatrics finds that antibiotics offer a safe option for avoiding invasive surgery—and saving a potentially useful organ.

Using Antibiotics to Avoid Unnecessary Surgery

We hear and talk a lot these days about the overuse of antibiotics. It is a real concern, and the overuse of antibiotics is rendering many of these important drugs useless to prevent infection in humans.

Yet there are many important uses of antibiotics, and treating an inflamed appendix, in many cases, is one of them. In a press release, lead author Nigel Hall, Associate Professor of Paediatric Surgery at the University of Southampton, noted:

Acute appendicitis is one of the most common general surgical emergencies worldwide and surgery has long been the gold standard of treatment. But it is invasive and costly, not to mention extremely daunting for the child concerned and their family. Our review shows that antibiotics could be an alternative treatment method for children.

When we compared the adult literature to the data in our review it suggested that antibiotic treatment of acute appendicitis is at least as effective in children as in adults. This now needs to be explored more widely.

In the analysis, scientists reviewed 10 studies that spanned the last decade for the effectiveness and safety of non-operative treatment for acute uncomplicated appendicitis in children. Researchers were able to report on 413 children who received antibiotics rather than undergoing appendectomy. Findings include:

• Between eight weeks and four years following incidence of appendicitis, 79% of children treated with antibiotics did not suffer recurrence. In several cases, children initially treated with antibiotics underwent appendectomy due to parental choice or continuing abdominal pain.
• Recurrent appendicitis occurred in 14% of children, leading to appendectomy.
• The study found that non-operative treatment is a safe option.

With ready access to medical care in the United States, parents usually have an option to choose antibiotics or surgery as the first course of treatment for their child with appendicitis. Surgery, even laparoscopic, involves general anesthesia, and about a 7% chance of complications.

With acute uncomplicated appendicitis, this study finds that the chances are good that antibiotics could resolve the inflammation without surgery, while stopping the infection and maintaining the appendix—which may have significant future health advantages.

When my own child's appendix went south, antibiotics delayed surgery by two months. Three times its normal size and ruptured by the time it was removed, I was not sorry to see it go.