Ask Dr. H: A burst appendix, and sent home

Question:

My son developed a fever and pain in his belly that turned out to be caused by a burst appendix. He was admitted to the hospital, but was sent home the next day without having surgery. I thought that was really strange. Can you tell me if that was the right thing to do?

Answer: Appendicitis is a true medical emergency, because if left untreated, the appendix can rupture and spill bacteria-laden digestive contents into the sterile abdominal cavity. This bacterial infection can be fatal.

That's why in the classic occurrence of a sudden onset of right lower abdominal pain in people with an appendix, the patient needs to go to a doctor or an emergency department without delay. We want to catch it before infection causes the appendix wall to perforate. The surgery for a nonperforated appendix is straightforward; the recovery occurs within days.

It might seem that the right course of action for a ruptured appendix is immediate surgery. But studies have shown that surgery at that point will just make the patient sicker. The best course of action for a ruptured appendix is to control infection with antibiotics (intravenous in the hospital; oral antibiotics at home); let the appendix cool down; send the patient home on several weeks of daily antibiotics, and safely remove the appendix four to six weeks later in a nonemergent fashion. Your son should be followed closely by his surgeon during this watchful waiting period. He should have a smooth recovery.

One problem surgeons face when delaying surgery is trying to convince a patient who feels great several weeks after hospital discharge that he still needs his appendix removed. Some folks don't follow up with their surgeon once the pain has resolved.