Is an operation necessary in every case of appendicitis?

Appendicitis

Q. Is an operation necessary in every case of appendicitis?

A. A surgeon should be consulted in every case of appendicitis. Each individual case must be judged on its merits. Severe cases of ap­pendicitis require prompt surgical intervention. In cases of chronic appendicitis the danger of a fatal issue is much less than in acute appen­dicitis, but the condition is one of too much gravity to be safely ignored.

At the beginning of an attack, the bowels should be moved by a large enema containing a little soap or an ounce of sulphate of mag­nesia. Apply hot hip and leg packs every three hours, with one or two ice-bags in the right groin continuously.

If the patient does not improve rapidly as a result of the thorough application of the above treatment, as shown by the lower temperature, a slower pulse, and relief of pain, a thoroughly competent surgeon should be consulted. The most desirable time for performing an oper­ation in a case of acute appendicitis is within the first twenty-four hours. Later than this, the disease is likely to be found extensively in­ volving the surrounding tissues and operation is much more difficult. In such cases, if the pa­tient shows indications of recovery, the opera­tion may be postponed to some days later when the symptoms of inflammation have disappeared. But if an operation is decided upon, it should be done promptly. Delay is perhaps unwise in any case in which operation is clearly shown to be necessary. When abscess results, as shown by thickening, swelling, continued pain, and temper­ ature, the abscess is usually opened and drained without attempt to remove the appendix. It must always be remembered that appendicitis is generally simply an extension of infection from the colon to the appendix. Removal of the ap­pendix will not cure the diseased colon. This must receive proper attention later.