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A story of a burst appendix and its owner who lived

What doesn't kill you makes you stronger, stand a little taller, right? Common Health blog begins a narrative post on one woman's burst-appendix survival with a warning that I'll repeat before going any further:

A perforated appendix can kill you. If you experience symptoms of appendicitis, particularly sharp pain in the lower right area of your  abdomen, get prompt medical care.

Now, the story. WBUR’s news director, Martha Little, shares her experience with writer Carey Goldberg, who reports that treatment for appendicitis may be evolving from automatic emergency-room surgery to more nuanced and less invasive treatments. Little tells her story from the first instance of abdominal pain to entering a hospital. She writes:

I finally made it to the Brigham & Women’s emergency room, where I was told I would likely have the appendix taken out that night. But  upon further examination, the surgeon and his resident told me that I could wait eight weeks for surgery, and meanwhile they would treat  the infection with serious antibiotics.

Eight weeks!? “What,” I said, “would happen if the appendix burst?”

“It has already burst,” they said.

What? I thought people died when their appendix burst.

No, I was told. Not always.

The body, they explained, has a way of “walling off” the perforated appendix so that the infection doesn’t spread.

Goldberg writes:

Here’s the good news for patients like Martha: The appendix is surrounded by other structures, mostly the intestine, and so, as she was  told, the seepage can get “walled off.” One theory, [Douglas Smink, MD, MPH, program director of the general surgery residency program at Brigham & Women’s Hospital ] said, is that a somewhat mobile layer of visceral fat called the omentum —  nicknamed “the policeman of the abdomen” — could be drawn toward areas of inflammation to contain infection. So a patient can end up with  a pus-filled abscess outside the appendix, covered partially by the omentum.

Still, why not just operate and get rid of the problem? It’s not so simple. An area rife with inflammation is hard for surgeons to work  with, Dr. Smink said, and an appendectomy could end up turning into removal of part of the intestine and colon as well.

So the idea is to give the patient antibiotics to fight the infection, wait as the inflammation subsides and then do an “interval  appendectomy,” after the waiting interval.

It should be noted that some research has shown that for some cases of uncomplicated appendicitis, with the appendix still intact, antibiotic treatment may be an effective alternative to surgery.

Photo by Shutterstock

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