Treatment
The treatment of acute appendicitis is
appendicectomy. There is a perception that urgent operation is essential to
prevent the increased morbidity and mortality of peritonitis. While there should
be no unnecessary delay, all patients, particularly those most at risk of
serious morbidity, benefit from a short period of intensive preoperative
preparation. Intravenous fluids sufficient to establish adequate urine output
(catheterisation is needed only in the very ill) and appropriate antibiotics
should be given. There is ample evidence that a single perioperative dose of
antibiotics reduces the incidence of postoperative wound infection. When
peritonitis is suspected, therapeutic intravenous antibiotics to cover
Gram-negative bacilli, as well as anaerobic cocci, should be given. Hyperpyrexia
in children should be treated with salicylates in addition to antibiotics and
intravenous fluids. With appropriate use of intravenous fluids and parentral
antibiotics, a policy of deferring appendicectomy after midnight to first case
on the following morning does not increase morbidity. However, when acute
obstructive appendicitis is recognised, operation should not be deferred longer
than it takes to optimise the patient’s condition.