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JAMA Patient Page
June 16, 2015

Appendicitis

JAMA. 2015;313(23):2394. doi:10.1001/jama.2015.6201

Appendicitis is a condition that, although seen more frequently in children, is common in adults.

The appendix is a structure in the lower right side of the abdomen attached to the colon. It has no known purpose. It may become inflamed and then infected. If the appendix ruptures, it can cause a serious infection inside the abdomen.

Symptoms of appendicitis usually start with not feeling very hungry and then feeling nauseated. Some people even vomit. Pain can develop in the middle of the abdomen and then move to the lower right side. It will hurt if you press on the lower right side of the abdomen. People with appendicitis usually also have a fever.

If you think you have appendicitis, you should seek medical attention. The doctor will feel your abdomen and obtain some blood tests; an ultrasound or computed tomography (CT) scan may be done to look at the appendix. Having a CT scan is very common because this test has become very good at letting physicians know if you do or do not have appendicitis.

Traditionally, when a diagnosis of appendicitis was made, a surgeon would remove the appendix as soon as possible to avoid rupture and infection. Not all patients with appendicitis experience a rupture, but it is impossible to know ahead of time who will or will not have this complication.

In the June 16, 2015, issue of JAMA, an article reports the results of treating patients with antibiotics instead of surgery for appendicitis. Most of the patients treated with antibiotics did not require surgery. Some patients developed appendicitis again after they completed their antibiotic treatment and underwent surgical removal of the appendix. None of these patients had serious complications related to the delay in performing an appendectomy.

There have been several studies of antibiotic treatment for appendicitis. All of them showed promising results suggesting that surgery may not be needed for all cases of appendicitis. Before all patients receive antibiotics instead of surgery, more studies should be performed.

The study reported in JAMA does not apply to all patients with appendicitis. The results do not apply if there is a stone (appendicolith) in the appendix, if there is concern about perforated (ruptured) appendicitis, or if there is an infection in the abdomen. The patients in the study were also given a specific antibiotic that is very powerful, and the study results apply only when similarly powerful antibiotics are used to treat appendicitis.

If you develop appendicitis, it is reasonable to ask your doctor whether antibiotics might be an option instead of surgery.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish. A Patient Page on appendectomy was published in the December 7, 2011, issue; one on acute appendicitis in children was published in the July 25, 2007, issue; one on hernias was published in the May 25, 2011, issue; one on acute abdominal pain was published in the September 27, 2006, issue; and one on general anesthesia was published in the March 9, 2011, issue.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Source: Salminen P, Paajanen H, Rautio T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. doi: 10.1001/jama.2015.6154.

Topic: Digestive Disorders

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