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Non-surgical treatment of perforated appendix?


Iwent to ER last week due to pain in mid right abdomen. CAT scan revealed perforated appendix with abscess. Doctors decided not to remove neither appendix nor abscess (appendix is at the back of bladder). I was on IV antibiotics and clear liquids for two days and left hospital with two week oral antibiotics (ciprofloxacin and metronidazole) and solid foods. It has been a week and I still feel mild pain on lower right quadrant with some gas, particulary today. I have read a lot regarding appendicitis treatment but it all involves removal of the appendix and haven't found any info for a case like mine. My question is: how long do I have to wait for these symptoms to go away or should I seek medical attention? Where can I find information or has someone had similar treatment? My discharge notification states perforated appendicitis as the diagnosis. Comorbid conditions: small bowel obstruction. Complications: wall-off intra abdominal abscess. Procedure: reversal of loop ileostomy.

clarification: Actually I never went on surgery, i.e. didn't have appendix removed nor have an ileostomy. What I wrote at the end was exactly what my doctor wrote in my dicharge notification. That's why Im so confused: I didn't have the appendix removed nor the abscess drained, I was only under IV antibiotics for two days and two weeks with oral ones. It's end of week one and feel less inflamation on abdomen but still some gas and pain. It sounds very atypical indeed and that is why I am asking for advice regarding prognosis and/or similar experiences.

Some of your details are a little confusing. Apparently, you had a bowel obstruction as well which would have required a partial bowel resection - the part of your bowel that contained the obstruction was removed. Your appendix would have been attached to that portion of removed bowel so, technically, there would not have been a need for an appendectomy as a separate surgery. A loop ileostomy was also performed during this surgery or you would not have required a reversal. A loop ileostomy reversal invoves removing the ileum from it's point of attachment to the anterior abdominal wall & skin and then re-connecting it to the remaining segment of colon. These surgeries are typically weeks to months apart so your account of the course of your illness is lacking some pretty important events. As for the abscesses, they have to be drained, not removed. Intra-abdominal abscesses are collections of pus/fluids that are a consequence of perforation. These collections are walled off by the omentum in the body's attempt to contain/limit the spread of infection. You would also need to be on antibiotics until your white blood cell count returned to normal and you were taking in a regular diet, usually 3-7 days. As you heal from your surgeries, you may very well experience some changes in your bowel movements and some gas. It would also not be uncommon for you to have some mild abominal pain after two major surgeries and if you still have abscesses. It sounds like you just might be a little confused by this whole process, it is complicated. Your best option would be to make an appointment with your surgeon & have him/her go over the procedures with you and explain the process. You should already have been scheduled for some follow up appointments which would be the perfect time for you to have your worries and questions addressed.

For your own peace of mind go to see the doctor. I suspect you would still be feeling some discomfort but if you are uncertain double check it with the doc. Like you I have only ever heard of the appendix being removed when theres a problem but maybe this is a medical advancement.
Hope you feel better soon.

I believe that the reason they did not remove your appendix is be cause of the ileostomy and why they did the reversal. When my husband's appendix perforated or ruptured, he began to go septic, and it was out within the hour of them finding it. I would go back and seek further medical attention this is not something that you will be able to go around with for some time.

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