What causes an inflamed appendix and how is it treated?

From the Guidelines

Appendicitis is caused by blockage of the appendix lumen, typically by a fecalith (hardened stool), lymphoid hyperplasia, or occasionally foreign bodies, which leads to increased pressure, bacterial overgrowth, inflammation, and potential perforation if untreated, and the standard treatment for acute appendicitis is surgical removal of the appendix (appendectomy) 1. The treatment approach for appendicitis involves several key considerations, including the use of antibiotics, the decision between laparoscopic and open surgery, and the management of complications such as perforation or abscess formation.

• Before surgery, patients typically receive intravenous antibiotics such as a combination of cefazolin (1-2g) and metronidazole (500mg), or piperacillin-tazobactam (3.375g) alone, to control infection 1.
• In select uncomplicated cases, antibiotic therapy alone may be considered, typically using a regimen of intravenous antibiotics for 1-3 days followed by oral antibiotics to complete a 7-10 day course, but this non-surgical approach carries a 25-30% risk of recurrence within a year 1.
• The use of laparoscopic appendectomy is recommended as the treatment of choice for patients with complicated appendicitis with phlegmon or abscess where advanced laparoscopic expertise is available, with a low threshold for conversion 1.
• Pain management with medications like acetaminophen or NSAIDs is also important, and patients should fast before surgery and follow post-operative instructions including gradual diet advancement, wound care, and limited physical activity for 1-2 weeks 1.
• Prompt medical attention for symptoms like right lower abdominal pain, nausea, vomiting, and fever is crucial as delayed treatment can lead to serious complications including perforation and peritonitis 1.
• The management of perforated appendicitis may involve non-operative management with antibiotics and percutaneous drainage, or operative management with laparoscopic surgery, depending on the availability of expertise and resources 1.
• Routine interval appendectomy after non-operative management for complicated appendicitis is not recommended for young adults (< 40 years old) and children, but is recommended for those patients with recurrent symptoms 1.

From the FDA Drug Label

Meropenem for injection is indicated for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron,and Peptostreptococcusspecies. The cause of an inflamed appendix is typically a bacterial infection.

• Bacterial infection is the primary cause of an inflamed appendix. The treatment for an inflamed appendix is typically antibiotics and/or surgery.
• Antibiotics such as meropenem 2 or ertapenem 3 may be used to treat the infection.
• Surgery may be necessary to remove the appendix.

From the Research

Causes of an Inflamed Appendix

The exact cause of an inflamed appendix is not specified in the provided studies. However, the studies discuss the treatment and management of acute appendicitis.

Treatment of an Inflamed Appendix

• Surgical removal of the inflamed appendix is the traditional treatment of choice for acute appendicitis, as stated in 4 and 5.
• Laparoscopic appendectomy is recommended as the treatment of choice when possible, due to its benefits in terms of access trauma, postoperative pain, wound infection rates, and convalescence 4.
• Antibiotic therapy has been proposed as an alternative to immediate appendectomy, with studies showing that it can be effective in treating acute appendicitis, but with a risk of recurrence 5, 6.
• The choice of treatment depends on the individual case and the severity of the appendicitis, with some studies suggesting that antibiotic therapy may be a viable option for patients with uncomplicated appendicitis 6.
• In some cases, interval appendectomy may not be necessary after treatment of a ruptured appendiceal mass, as the inflammation may resolve on its own 7.
• However, there is a risk of stump appendicitis after laparoscopic appendicectomy, which can require further surgery 8.