APPENDICITIS
Appendicitis is often thought to be a disease only to be seen in the developed world. It is however a frequent emergency here in Aira. Unfortunately the patients still tend to arrive very late - often with generalized peritonitis due to perforation.
If there is already an established periappendicular abscess without complications such as obstruction or perforation it is better to abstain from surgery and rely on conservative treatment – that is fasting, i.v. fluids and antibiotics. Interval appendectomy (“appendectomie a froid”) later on is not needed.
As always keep it simple when performing appendectomy. Purse string sutures are unnecessary, a simple ligation of the appendicular stump is sufficient. No iodine on the stump is needed. Do not waste time closing the peritoneum - only the fascia and skin needs to be closed.
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If there is severe contamination the wound should be left open without suturing the skin. In this way annoying wound infection is avoided.
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The wound can be closed by secondary suture a couple of days later, or left for spontaneous healing. I prefer the later alternative – it saves time, energy and money. The final scar is surprisingly inconspicuous – actually more esthetic looking than after suturing.
Drains are not needed except when dealing with a well established abscess.
Metronidazole for i.v. administration is very expensive. 4 tablets (1 gram) rectally BID is just as efficient and cost only a fraction of what you have to pay for the i.v. solution.
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