Burst appendix treated with antibiotics, anyone else?

spurious

Long story made short, was admitted to hospital a couple of weeks ago with a burst appendix which was treated by flooding me with antibiotics.
To be honest, I'd never heard of this approach and was in the "burst appendix = dying/immediate operation" camp. I'm glad they didn't tell me it had burst in the hospital as I would have freaked out. I've since discovered there have been other cases like mine.

http://commonhealth.wbur.org/2012/07/burst-appendix-appendectomy

Wondering if there's anyone on boards who was in a similar situation, or has experience of it? I've to go in for an appendectomy in about eight weeks or so when the appendix is 'cold'.

Xeyn

spurious wrote: »

Long story made short, was admitted to hospital a couple of weeks ago with a burst appendix which was treated by flooding me with antibiotics.
To be honest, I'd never heard of this approach and was in the "burst appendix = dying/immediate operation" camp. I'm glad they didn't tell me it had burst in the hospital as I would have freaked out. I've since discovered there have been other cases like mine.

http://commonhealth.wbur.org/2012/07/burst-appendix-appendectomy

Wondering if there's anyone on boards who was in a similar situation, or has experience of it? I've to go in for an appendectomy in about eight weeks or so when the appendix is 'cold'.

Sometimes the appendix ruptures but seals itself before overwhelming sepsis sets in. The resultant pathology can evolve into an appendeceal mass which most studies have shown to be best treated with antibiotics and an interval appendecectomy (although some research suggests this may not be needed)
A 'burst appendix' can be life threatening or not at all.

spurious

Thanks for the reply. It's interesting I think, how approaches for certain conditions change over time.

I didn't have as much pain as I've seen others have with it, or perhaps I have a very high threshold, I don't know. I'll be happy enough when they take it out, so I don't have a repeat.

Absolute eye-opener in A&E and on the ward. I take my hat off to anyone who works in the frontline Health Services here.

Xeyn

Acute appendicitis usually involves increasing abdominal pain to the local (or in rupture - generalised) peritonitis which is extremely painful, do the point you dont want to move in case it sets off the pain. What you describe might what is termed a 'grumbling appendix'. Which doesnt typically follow the usual presentation of acute appendicitis.

The front line services in this country are great despite the obstacles the HSE and the minister of health throws at them. I only worked as an A+E doctor for 6 months, and whilst I enjoyed it I would not want to make a career out of it. You get abuse from every corner - Patients, relatives, most other medical/surgical specialities... Nurses are generally great in A+E and the pre hospital care from the paramedics tends to be a very high standard from my experience. Its a pity the working conditions are driving some of these highly skilled workers from these shores.

RobFowl

Mod note, feel free to discuss this topic but just be acareful not to ask for or give personal advice.
BTW this is not directed any any specific poster.

I would be quite interested in seeing any peer reviewed articles on this. Not one who usually frequents surgical journals so wouldn't know where to start...

Xeyn

RobFowl wrote: »

Mod note, feel free to discuss this topic but just be acareful not to ask for or give personal advice.
BTW this is not directed any any specific poster.

I would be quite interested in seeing any peer reviewed articles on this. Not one who usually frequents surgical journals so wouldn't know where to start...

Completely forgot to come back to this. Recent surgical meeting got me to remember though.
There have been several studies for treating perforated appendixes conservatively - obviously conditions have to be met, we're not talking overt peritonitis but where self containment has been achieved and abcess/phlegmon formed.
Some studies as I eluded to even suggest an interval appendecectomy is not needed.

http://www.ncbi.nlm.nih.gov/pubmed/17968164

http://www.ncbi.nlm.nih.gov/pubmed/17868409

http://www.ncbi.nlm.nih.gov/pubmed/19846094

There's a good few more on the subject.

I myself would be reluctant not to remove an appendix in someone over 30 or any adult as the incidence for tumour (benign or malignant) is around 1% of appendectomy specimens. So it's probably safe to leave alone in younger patients but not older ones.

spurious

Xeyn wrote: »

Some studies as I eluded to even suggest an interval appendecectomy is not needed.

Just for completeness and as an update on the original post, I was back at out-patients recently and they have decided since I have had no further trouble or pain from it, that there is no need at the moment for an appendectomy.

4umbrellas

There's a Cochrane systematic review on this. Too new to post links but it's here (add www at the beginning): ncbi.nlm.nih.gov/pubmed/22071846. No firm conclusions on preferred treatment.

Galbin

Way back in 2001 I developed symptoms. I was in Germany at the time, and so was admitted to hospital. Test after test failed to find anything wrong, so I was referred to a specialist. He did more tests and then said that the problem was with my appendix. I was very young at the time, so didn't think to get all the details like I would nowadays. However, he definitely said that the issue was my appendix and he prescribed antibiotics for it. They worked very well and no issues with my appendix since. So there definitely is something to the antibiotics as an effective treatment.

Just one isolated case study for you...

exgp

I once knew a Dr who had served on nuclear submarines and later on liners. He reckoned that over his career he had seen up to thirty cases of Appendicitis. He treated them all with antibiotics as he felt that that would be safer than him operating. They all survived.

Graces7

Sound great indeed. How widely available though?

exgp

Graces7 wrote: »

Sound great indeed. How widely available though?

Only if you happen to be on a submarine I suppose.

gctest50

exgp wrote: »

Only if you happen to be on a submarine I suppose.

could be tricky at times

I worked without gloves. It was hard to see. The mirror helps, but it also hinders -- after all, it's showing things backwards. I work mainly by touch. The bleeding is quite heavy, but I take my time -- I try to work surely. Opening the peritoneum, I injured the blind gut and had to sew it up. Suddenly it flashed through my mind: there are more injuries here and I didn't notice them ... I grow weaker and weaker, my head starts to spin. Every 4-5 minutes I rest for 20-25 seconds. Finally, here it is, the cursed appendage! With horror I notice the dark stain at its base. That means just a day longer and it would have burst and ...
At the worst moment of removing the appendix I flagged: my heart seized up and noticeably slowed; my hands felt like rubber. Well, I thought, it's going to end badly. And all that was left was removing the appendix ... And then I realised that, basically, I was already saved.


- Doctor Rogonov


http://www.theatlantic.com/technology/archive/2011/03/antarctica-1961-a-soviet-surgeon-has-to-remove-his-own-appendix/72445/

sleepyheadh

This is hilarious lads..The overwhelming stench of hypocrisy from this thread is gas! Fair play to all involved ;-)

Xeyn

Care to expand on that remark?

sleepyheadh

Xeyn wrote: »

Care to expand on that remark?

Discussing medical advice, is banned on boards as a general rule.

I have been castigated by countless mods, for bringing up the discussion of medical advice. Yet, Spurious, a CatMod, who should be fairly familiar with the site wide rules regarding Medical advice, is allowed to discuss it all they wish.

The end result is actually quite an interesting thread, with some good advice with some interesting references attached. This is exactly what I have been saying would happen, if the discussion of medical advice was allowed. Quite the opposite to what the mods of Health Sciences would have you believe. They feel that this is end up in deaths and boards being sued for some reason.

P.s Xeyn, you better read this fast, because I can guarantee that this post will be deleted.

sam34

Nowhere in his/her post did spurious ask for medical advice.
They outlined what treatment they had already received from medical professionals, and started a discussion on that treatment, which interested them as they had not encountered it before. They didn't come along listing about their symptoms and asking for a diagnosis to be made online or for treatment to be suggested based on their post.
To suggest that their post is looking for medical advice is really quite ridiculous.

sleepyheadh

spurious wrote: »

Long story made short, was admitted to hospital a couple of weeks ago with a burst appendix which was treated by flooding me with antibiotics.

Wondering if there's anyone on boards who was in a similar situation, or has experience of it?.

Quote from Vorsprung (Which you thanked Sam34)- "A reminder to all posters on this forum:

We do not offer medical advice, nor do we allow comment/discussion of people's personal medical situations. If you start threads that include such queries, they will be closed.

There are no exceptions, and a mod's decision is final."

And, to quote yourself Sam34 - "there is a zero tolerance policy on medical advice here, irrespective of how innocuous or general it seems.

all such threads will be locked. there will be no comments made/advice given re peoples personal health/medical situations."

Spurious is discussing their own medical situation, and is looking for general information about the procedure and treatment (innocuous) but certainly not allowed.

RobFowl

Questioning Mod actions in thread is not allowed
Rob

sleepyheadh

RobFowl again in the sticky, on a comment posted by Sam34

Quote:
Originally Posted by sam34
"OK, charter update.

there is a zero tolerance policy on medical advice here, irrespective of how innocuous or general it seems. there will be no coments made/advice given on peoples personal health/medical situations.

all such threads will be locked.

however, that has been policy for some time and we still get the advice threads.

so, we have decided to infract posters seeking medical advice from here on in. (obviously, if any poster gives medical advice prior to a thread getting locked, they too will be infracted).

there is no point PMing us afterwards saying "ah come on i wasnt looking for advice as such..." - zero tolerance is zero tolerance.

the reasons for this have already been explained in this thread and in the charter.

no further warnings. dont PM telling us you werent aware - its in the charter and in the big sticky."

To which RobFowl responded

"Can I just remind everyone of this !!
PS asking for peoples "experiences" of a certain treatment, doctor or hospital etc IS asking for medical advice no matter how much you protest it isn't ....."

And has a mod actually made an action Rob that I have gone against?

sam34

This isn't rocket science.

There's a world of difference between "I have symptoms x, y and z, what could that be? Should I have treatment a or treatment b?" And "I developed condition x and had treatment y recommended by the treating doctor. I had t heard of treatment y before so I'm curious about it and decided to start a thread here to see if others had it or knew about it"

(I'm paraphrasing, but the point stands)

Kurtosis

Not quite on-topic as dealing with uncomplicated acute appendicitis but this recent study looked at the effect of appendectomy vs antibiotics on resolution of the appendicitis with no recurrence within 1 year. Although the study was not able to demonstrate non-inferiority, 90% of the antibiotic group were discharged without surgery and 70% had no recurrence with a year.