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The best treatment for appendicitis is surgery to remove the appendix (appendectomy) before the appendix ruptures. While awaiting surgery, the patient will be given IV fluids to keep well hydrated. The patient will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery.
Surgery is commonly performed via laparoscopy, a minimally invasive procedure where small "keyhole" incisions are made in the abdomen and the appendix is removed with the assistance of a small camera guided by the surgeon. However, in some cases it may be necessary to do an open abdominal procedure to remove the appendix.
Occasionally, surgery for appendicitis reveals a non-inflamed appendix (negative appendectomy), with high rates in infants, the elderly, and young women. However, the use of imaging studies (CT scans, ultrasounds) appears to have reduced the negative appendectomy rate to 7%-12%. The difficulty in making a definite diagnosis of this medical problem and the risk of missing an acutely inflamed appendix (and the patient becoming very ill due to perforation) makes a certain rate of misdiagnosis inevitable. Women in particular have a high rate of negative appendectomy as ovarian and uterine problems make the diagnosis more difficult. CT scanning prior to surgery has been shown to decrease this percentage to closer to 7% to 8% in women.
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