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April 9, 1982

Treatment of Perforated Appendicitis

JAMA. 1982;247(14):1939. doi:10.1001/jama.1982.03320390023027

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To the Editor.—  The editorial by the late Alton Ochsner, MD (1981; 246:2453), addresses the problem of emergency appendectomy by non-qualified physicians. I remember that during World War II, several patients lost their lives owing to the shortage of trained surgeons in a smaller community.However, with modern, rapid, transport facilities, antibiotic coverage, and general supportive management, the treatment of perforated appendicitis may be less conservative, as the latter approach creates its own problems.I myself have been suffering from extensive peritoneal adhesions following nonsurgical treatment of appendicitis and have had two different attacks of fulminating small-bowel strangulation with gangrene, producing a life-threatening emergency and necessitating each time the sacrifice of about 91 cm of small bowel. Two prominent medical centers failed to recognize the cause of the abdominal symptoms before these attacks.Recently some painful abdominal symptoms have recurred, and I have to be prepared for a third emergency,