How Doctors Can Treat an Inflamed Appendix Without Surgery

Antibiotics may be an alternative

Prescription medicine pills pouring out of orange bottle. White background with reflective surface.

About 7 percent of the U.S. population eventually develops an inflamed appendix. The standard treatment in the United States is the surgical removal of the organ. But not every inflamed appendix needs to come out, new research shows.

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The study finds that in uncomplicated cases, most patients with an inflamed appendix  can be treated successfully with antibiotics instead of having to undergo surgery.

“Antibiotic therapy may be an option for some patients,” surgeon Matthew Kroh, MD says.

Treatment without surgery

An uncomplicated case usually means the appendix is swollen, but has not ruptured. If left untreated, the inflamed appendix can develop into a complicated case. This means the patient may develop issues such as fluid formation or small holes in the appendix.

“It’s not common that those developments may happen, but it’s a feared complication without an operation,” says Dr. Kroh.

This is why doctors ideally want to remove an appendix within 24 hours of the onset of severe symptoms.

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Scientists at Turku University Hospital in Finland split 530 people with uncomplicated cases of inflamed appendix into two groups. One group received antibiotic treatment, while the other group underwent surgery. Researchers followed both groups for one year.

Results show that 72 percent of the people who received antibiotics did not require removal of their appendix.

The medical term for removal of the appendix is an appendectomy. The procedure has long been considered the standard of treatment for when an appendix becomes inflamed, which is called appendicitis.  Surgeons perform more than 300,000 of them in the United States every year.  Often, surgeons remove the appendix laparoscopically through a small incision in the stomach. The technique has improved surgical complication rates, but the procedure is not without risk.

Treating appendicitis with antibiotics is gaining popularity among doctors in Europe. But the treatment has not been accepted as the routine standard of care in the United States.

The study provides more evidence that the use of antibiotics instead of surgery may be an option for some patients with appendicitis, Dr. Kroh says.

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“Historically, intervention for appendicitis has been urgent,” Dr. Kroh says.  “The expectation is that the appendix should come out to avoid complications, perforations and infections.”

Symptoms of appendicitis

Because the appendix resides in the lower right portion of the abdomen, the most important symptom is lower abdominal pain. This often starts around the belly button and moves to the lower right side later.

Other symptoms include:

  • nausea and vomiting
  • loss of appetite
  • low-grade fever
  • diarrhea (after several days)
  • pain or increase in urination