Appendicitis

Our Approach In Managing Appendicitis

Recognise quickly. Operate promptly. Recover fully.

Appendicitis is the classic example of a condition where speed of diagnosis directly determines the complexity of treatment and the patient's recovery experience. A patient presenting within the first 24 to 48 hours of symptom onset, before rupture occurs, typically undergoes a straightforward, brief laparoscopic procedure with discharge the following day.

A patient who delays - whether through misdiagnosis, fear, or simple unawareness - and develops a ruptured appendix with peritonitis faces a significantly more complex surgical and recovery journey.

Our approach to acute appendicitis diagnosis and same-day surgery at Shree Hospitals prioritises rapid assessment from the moment a patient with abdominal pain arrives in our emergency department. Our appendix removal specialists are available at all hours, keeping the time between diagnosis and surgical treatment to an absolute minimum.

1. Rapid Clinical & Diagnostic Assessment

• Detailed history and examination: Classic migratory pain pattern from the periumbilical region to the right lower quadrant, with associated tenderness, guarding, and rebound tenderness.
• Alvarado scoring system: A structured clinical tool combining symptoms, signs, and basic blood tests to estimate appendicitis probability.
• Full blood count: An elevated white blood cell count can support the diagnosis, although a normal count does not exclude appendicitis.
• Ultrasound abdomen: First-line imaging, particularly valuable in children, young women, and pregnant patients to avoid radiation exposure.
• CT abdomen with contrast: An important imaging modality for acute appendicitis diagnosis and same-day surgery planning, especially in atypical presentations or obese patients.
• Pregnancy testing: Testing in women of reproductive age to help exclude ectopic pregnancy as a differential diagnosis.

2. Pre-Operative Optimisation

Once the diagnosis is confirmed, rapid preparation for theatre minimises further risk:

• IV fluid resuscitation: Correction of any electrolyte abnormalities.
• IV antibiotic administration: Broad-spectrum coverage initiated promptly, particularly if perforation is suspected.
• Analgesia for pain control: Adequate pain relief without unnecessarily delaying the diagnostic process.
• Anaesthetic assessment and informed consent: Completed efficiently to enable surgery within the appropriate time frame.
• NPO (nil by mouth): Food and fluid intake managed according to anaesthetic instructions and theatre timing.

3. Laparoscopic Appendectomy

Laparoscopic appendectomy is the preferred surgical approach for many patients with appendicitis:

• Three small keyhole incisions: Generally associated with less post-operative pain and smaller scars compared with open surgery.
• Direct visualisation of the abdominal cavity: Helps confirm the diagnosis and assess alternative causes of symptoms when the appendix appears normal.
• Peritoneal washout when indicated: In selected cases of perforation or contamination, washing out the abdominal cavity may form part of the surgical treatment.
• Histopathological examination: The removed appendix can be sent for examination to confirm the diagnosis and identify unexpected abnormalities.
• Same-day or next-day discharge: Some patients with uncomplicated appendicitis may be discharged early after recovery, as part of emergency laparoscopic appendectomy and surgical care in Mumbai.

4. Management of Complicated Appendicitis

A ruptured appendix, peritonitis, or abscess formation may require a more individualised treatment approach:

• Open appendectomy: May be considered when extensive inflammation or dense adhesions make a laparoscopic approach unsuitable.
• Percutaneous abscess drainage: Image-guided drainage may be considered for a well-formed periappendiceal abscess. Further surgery depends on the patient's clinical condition and treatment plan.
• IV antibiotic course: Antibiotic selection and duration are tailored to the severity of infection and clinical response.
• Close post-operative monitoring: Assessment for ongoing sepsis, wound infection, or an intra-abdominal collection.

5. Non-Operative Management for Uncomplicated Appendicitis

In carefully selected cases, antibiotic-first treatment may be an alternative to surgery after a discussion of the benefits, limitations, and risks:

• Antibiotic therapy: IV and/or oral antibiotics may be considered for selected patients without evidence of complicated appendicitis.
• Recurrence risk counselling: Patients should understand that symptoms can recur and that appendectomy may be needed later. Recurrence risk varies with patient selection and follow-up duration.
• Close monitoring: Clinical reassessment is important, with prompt surgical review if symptoms persist or worsen.
• Shared decision-making: The choice between surgery and antibiotic-first treatment depends on the clinical findings and the patient's preferences.

6. Post-Operative Recovery & Follow-Up

• Early mobilisation and oral intake: Resumed as tolerated after surgery, according to the treating team's advice.
• Hospital discharge: Many patients with uncomplicated appendicitis can leave hospital within 24 hours if recovery is satisfactory.
• Return to normal activities: Recovery time varies according to the surgical approach, individual health, and any complications.
• Recovery after complicated appendicitis: Perforation or peritonitis may require a longer hospital stay, additional antibiotics, and closer monitoring.
• Wound care and follow-up: Patients receive guidance on wound care, activity restrictions, warning signs, and follow-up as part of appendicitis treatment in Mumbai, India.