Why can't appendicitis be treated with just antibiotics?

[caters]

I started having appendicitis 3 nights ago. It woke me up from sleep with lots of pain and nausea. I took pepto-bismol for the nausea but despite the fact that it had salicylic acid which is the prodrug of aspirin and releives pain by affecting genetic expression of the COX enzyme that forms prostaglandins, it didn't help with the pain at all. The pain was low when I went back to sleep(about a 4 on a scale of 1 to 10, bad enough that I knew something was up, but not so bad I couldn't sleep. My momma told my dad that I was worried that this pain was appendicitis.

My right lower quadrant was also very tender. I woke up with pain that was even worse. It was at a 6 and approaching an 8. I was on the verge of crying in pain. I texted my dad and then woke up my momma and went to the hospital. They did a bunch of tests, all of which except the C reactive protein and CT were normal, even my temperature was normal.

The only clue that they had from the exam was that I was nauseous and in pain at a steady 6 with tenderness and guarding. The CT scan showed an infection at the tip of my appendix with the rest of the appendix looking normal. This meant that I was in a very early stage of appendicitis.

I stayed in the hospital for the night and had an appendectomy done the next morning. They did it laproscopically because my appendix was intact. The nausea and other symptoms went away after I woke up from the anesthesia. My throat was and still is sore because they had to put a breathing tube in while they were taking out my appendix.

When I went home that evening I immediately threw up which is normal after an appendectomy. I only threw up once and my stomach calmed down in minutes.

It is kind of a shame that the appendix is known by scientists to help recolonise the digestive system with good bacteria after vomiting or having diarrhea, yet appendicitis still has to be treated with an appendectomy.

Why can't appendicitis just be treated with antibiotics or if the appendix is obstructed, a colonoscopy be done to take out the obstruction that is causing the appendicitis? I mean, that sounds much better than getting rid of your appendix and I could still do situps or swim afterwards without waiting for a week or 2 until my abdomen heals. Nevertheless, despite there being some successes with just antibiotics(and I bet a lot of those are with people in early appendicitis like I was), most doctors agree that even in early appendicitis, appendectomy is the way to go.

 

[Ygggdrasil]

I am not a doctor, but many sources suggest that most cases of appendicitis can be treated only with antibiotics (e.g. see http://www.webmd.com/digestive-diso...citis-can-often-be-treated-with-antibiotics#1). However, doctors and the hospitals they work for probably get paid more for appendectomy than for prescribing antibiotics. Many have argued these perverse incentives are why the healthcare costs in the US are vastly higher than in other countries (see for example, http://www.nytimes.com/2013/06/02/h...ld-in-health-expenditures.html?pagewanted=all)

 

[Dr.D]

I suspect a factor is the danger that the appendix will burst, that is, have structural damage that antibiotics cannot repair. If that happens, the abdominal cavity is flooded with bacteria and you are in serious trouble.

 

[berkeman]

I stayed in the hospital for the night and had an appendectomy done the next morning. They did it laproscopically because my appendix was intact. The nausea and other symptoms went away after I woke up from the anesthesia. My throat was and still is sore because they had to put a breathing tube in while they were taking out my appendix.

Very glad that you are okay now, @caters And yeah, the sore throat from the intubation is very common.

 

[Steelwolf]

If people KNOW what it is that is bothering them then they can get effective treatment often involving a goodly run of antibiotics. However, that being said, most people are generally clueless about most things medical and do not know specific signs of such problem: They rely on doctors to tell them what is wrong. Thus, by the time the Problem is far enough along and the person reports, generally to a Hospital, the infection has progressed enough that the appendix is enlarged, inflamed and usually well along the infection arc, so it is easiest, as well as most expedient, to remove the appendix at this point. I had that happen to me in the Navy, and even though I Knew it was appendicitis it was hard convincing the Navy Docs till my fever went thru the roof, for sure it was no fun experience, thank you! I certainly feel for you Caters, hope you heal quickly and get back on your feet and to doing active things again. Be Safe, Be Well!

 

[Laroxe]

Appendicitis can be treated with antibiotics and this has been a regular subject of studies, generally the results are inconsistent. Its generally thought that a blockage precedes the infection and so recurrence is more likely, interestingly as the infection worsens and an abdominal mass can be felt the usual management is antibiotics followed by surgery. There seems to be support for using antibiotics as first line treatment in children but generally until the evidence becomes clearer, surgery is considered the gold standard in most countries. For a little light reading;
https://www.evidence.nhs.uk/search?q=appendicitis+antibiotics