Quote:
Originally posted by DoctorDoom
Even in patients with ruptured appendicitis it is often advisable to treat with IV antibiotics until the disease "cools down;" it's impossible to operate in an inflamed area with friable tissue. IV abx for about a week, observation, and then discharge with PO abx for follow up surgery is indicated in that situation. In field conditions I would imagine broad spectrum IV abx as treatment until evac is possible should be considered. Definitive treatment remains surgical.
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be careful what you write.... there are different categories of a perforated appendix. It can perforate freely into the abdominal cavity or it can perforate and form a loculated abscess. The former requires immediate surgical intervention and no "cooling down" period. It is only the later case, which is less common, that you would treat with drainage and IV antibiotics and treat with an interval appendectomy rather than just intervening immediately.
I do agree that for the TS IV antiobiotics and hydration would be the indicated treatment until evac. I know of two surgical residents that resolved their bouts of acute appendicitis with antibiotics rather than undergo surgery.... they didn't want to mess up the call schedule by being out and chose this option. Obviously, this was before the 80 hour work week began.
doc t.