Surgery or antibiotics needed for a ruptured appendix?

Dr. Keith Roach

Question: A co-worker of mine recently had a ruptured appendix. The doctors did not remove it, but instead gave him heavy doses of antibiotics for three weeks. I thought they had to remove it. What is going on? — D.M.

Answer: Surgery remains the preferred therapy for acute appendicitis, the inflammation of the appendix of the large intestine. Nonoperative management can be used in people with uncomplicated appendicitis — which might be valuable for some, especially people with a history of surgical complications. However, 27 percent of people assigned to antibiotics needed surgery anyway.

Importantly, people with a ruptured appendix have been excluded from most of these studies (rupture is considered a complication). I did find a study in children comparing antibiotics with surgery for ruptured appendix, but the surgery group had significantly better outcomes.

I am not sure why your co-worker received antibiotics for a ruptured appendix. There may be a time when we will be better able to identify who can safely be treated with antibiotics and who needs surgery, but for now, most surgeons still recommend surgery. It is a safe procedure for the vast majority of patients with acute appendicitis.

Q: I’m a Type 1 diabetic who was diagnosed with common variable immunodeficiency. Can you tell me about this, and whether it might be related to my diabetes? — J.B.

A: Common variable immunodeficiency is, despite its name, not a common condition. It does indeed cause immune deficiency and increased susceptibility to infection and malignancies. Further, the condition may be so mild as to go unnoticed in some people, while others have recurrent infections or inflammatory conditions. The hallmark of the syndrome is a very low level of immunoglobulins (antibodies) in the blood. Although usually present at birth, most are diagnosed between ages 20 and 45. Thus, there often is a long delay in diagnosis.

Because CVID is not one disease but many, there are many manifestations of this condition. However, recurring infections, especially pneumonias or sinus infections, should prompt a clinician to consider testing for this condition.