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.