Is Non-Surgical Treatment for Appendicitis Risky? Recurrence Rates

Is the likelihood of recurrence high if appendicitis is not treated surgically?

Doctor, I visited a nearby clinic on March 15th due to upper abdominal pain, and I was diagnosed with gastroenteritis.
Three days later, as the pain shifted to my lower right abdomen, I went to a larger hospital.
Pressing on the lower right abdomen caused significant pain, but it was not painful when released.
After a CT scan, I was diagnosed with acute appendicitis.
Fortunately, there was no perforation or peritonitis.
After receiving a dose of antibiotics in the emergency room that day, the pain significantly subsided.
Since it was a Sunday, I ended up waiting nearly a day for a doctor at the hospital.
The appendicitis had been untreated for four days before I started receiving treatment.
The doctor initially mentioned that acute appendicitis could be managed without surgery, and foreign literature states that the recurrence rate is 20%.
Hearing this, I felt the recurrence risk was relatively low, and since I was completely pain-free at that time, I chose to proceed with antibiotic treatment.
However, after doing some research, I found that most articles suggest the recurrence rate is quite high.
I would like to ask the doctor about my situation: is the likelihood of recurrence significant? Should I consider a prophylactic appendectomy after some time, or wait until a recurrence occurs before undergoing appendectomy? If I wait until a recurrence to have the surgery, is there a higher risk of developing peritonitis? Please clarify for me.

Xiao Wan, 30~39 year old female. Ask Date: 2017/03/22

Dr. Chen Jiaming reply Surgery

Basically, if acute appendicitis is diagnosed and there are no specific reasons that make anesthesia and surgery inappropriate, such as poor cardiopulmonary status in the elderly or severe coagulopathy, it is generally recommended to arrange for an appendectomy as the appropriate treatment.
Conservative treatment with antibiotics alone is not advised.
This consideration can be divided into two aspects: first, the success of conservative treatment carries certain risks.
Patients diagnosed early have a better chance of successful conservative management.
However, if the tissue inflammation is too severe, initial antibiotic treatment may reduce pain due to the decrease in surrounding inflammation (making symptom improvement seem effective), but the appendiceal tissue itself may not withstand the prior severe inflammation, leading to a sudden perforation and more serious peritonitis.
Even if immediate surgery is performed, this can increase the likelihood of future intestinal adhesions.
Furthermore, if you, like others, successfully undergo conservative treatment (without an appendectomy), you may still bear the psychological burden of "when will it recur?" since abdominal pain is a common symptom in daily life, associated with conditions like gastroenteritis or dyspepsia.
However, having been informed of the possibility of recurrent appendicitis can feel like living with a ticking time bomb, leading to frequent hospital visits at the first sign of abdominal pain for fear of treatment delays.
Over time, after being told multiple times that it is not a recurrence of appendicitis, one may become complacent.
Regarding recurrence rates, it is a statistical term; whether you are lucky or unlucky, if you experience it, the chance is 100%, and if you do not, it is 0%.
This personal statistic is unique to you for your entire life.
Under the current healthcare insurance system, preventive appendectomy may require out-of-pocket expenses (approximately several thousand dollars), and even medical insurance may not cover it.
I personally recommend waiting until a recurrence occurs before proceeding with surgery, as long as you do not delay treatment, the likelihood of developing clinical peritonitis due to recurrent acute appendicitis is generally not increased.
I sincerely suggest: 1.
Take good care of your gastrointestinal health to reduce the chances of abdominal pain (pay attention to the timing and content of your diet, and seek early treatment for peptic ulcers).
2.
If you experience unexplained upper abdominal pain, you can press on the lower right abdomen (the actual location of the appendix) to check for early signs of referred pain from appendicitis.
3.
Avoid self-medicating with pain relievers; if you experience "persistent abdominal pain," be sure to inform your healthcare provider of your history of conservative treatment for appendicitis.
I hope this information is helpful to you!

Reply Date: 2017/03/22

More Info

The decision to treat acute appendicitis non-surgically, primarily with antibiotics, has become a topic of increasing interest and research in recent years. Your situation, where you were diagnosed with acute appendicitis but opted for antibiotic treatment instead of surgery, is not uncommon. However, it does raise important questions about the risks and recurrence rates associated with this approach.

Acute appendicitis is traditionally treated with an appendectomy, which is the surgical removal of the appendix. This is due to the risk of complications such as perforation and peritonitis, which can occur if the appendix becomes inflamed and ruptures. In your case, it seems that you were fortunate to avoid these complications, as your appendicitis was diagnosed early and treated with antibiotics.

The non-surgical management of appendicitis has shown promise in certain studies, with some research indicating that antibiotic treatment can be effective in managing uncomplicated cases. The reported recurrence rates for non-surgical treatment can vary widely, with some studies suggesting rates as low as 20%, while others indicate that the recurrence could be as high as 30-40% or more. This variability often depends on factors such as the patient population, the severity of the appendicitis, and the criteria used to define recurrence.

In your specific case, since you have already experienced an episode of appendicitis, there is a possibility that you may experience another episode in the future. The risk of recurrence is indeed a significant consideration. If you choose to wait for symptoms to recur before opting for an appendectomy, there is a risk that the next episode could be more severe, potentially leading to complications like perforation or peritonitis, which would necessitate emergency surgery.

On the other hand, some patients and physicians advocate for a proactive approach, suggesting that if a patient has had one episode of appendicitis, it may be prudent to consider an elective appendectomy to prevent future episodes. This is particularly relevant if the patient has a history of severe symptoms or complications.

Ultimately, the decision should be made in consultation with your healthcare provider, who can assess your individual risk factors, the severity of your initial appendicitis, and your overall health. They may recommend monitoring your condition closely and considering an appendectomy if you experience any recurrence of symptoms. It is also essential to discuss the potential risks and benefits of both approaches, including the likelihood of complications with recurrent appendicitis versus the risks associated with surgery.

In summary, while non-surgical treatment for appendicitis can be effective for some patients, it does carry a risk of recurrence. If you are concerned about the possibility of future episodes, discussing the option of an elective appendectomy with your doctor may be a wise course of action. They can provide personalized advice based on your medical history and current health status, helping you make an informed decision about your treatment options.

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