Can a person with a burst appendix be saved?

Question

I've been having an argument with someone who insists that if someone's appendix bursts, they are going to die, period, and the only thing that can be done for them is to give them painkillers. The only actual support he has for this assertion is "it's common sense" and "antibiotics don't work that fast". I quoted the wikipedia article on appendicitis which says that peritonitis is life-threatening but doesn't say anything about it being always inevitably fatal, but he just made fun of me for citing wikipedia.

Which one of us is right? Is it possible for a person with a burst appendix to be treated and survive?

Answer 1

if you can get immediate treatment for a burst appendix then you wont always die. it may feel like it would be less painful if you would but with modern medicine they should be able to treat and help you.

BUT if you take too long to seek medical treatment then chances go up that the recovery  would be less likely to happen

Answer 2

Yes, you can survive a burst appendix.  It hurts like h**l and you'll be in the hospital for, at least, a week but as long as you get treated, it shouldn't kill you.

Answer 3

I knew a gal who survived it.  Time is critical.

Answer 4

A person can survive after a burst appendix for 4-5 days or more. As soon as the appendix rupture the omentum in the abdomen immediately surrounds the appendix and arrest further spread in the abdomen. It will than form an appendicular abscess which has to be drain out with an operation. The best treatment is immediate operation before the burst if already burst generalised peritonitis may or may not happen(if yes unlucky but still manageable). Before the antibiotic the omentum usually keep the appendix surrounded making other organs in the abdomen safe. Nowadays people dont usually dies of burst appendicitis.

Answer 5

Yes such an unlucky person can be saved. Timing is critical. They won't live very long with a burst appendix so they must go into surgery ASAP.  

Answer 6

So far, Tank has given you the most correct answer.

Appendicitis is a very common problem and because the treatment is so simple, there aren't many doctors writing scientific papers about it.  It's just not that interesting.  However, there are all kinds of oddities that happen in regard to the appendix.  Ask any surgeon!

There are two age groups that tend to get appendicitis.  One is young kids and the other is young adults.  It can happen at any age, of course, but you're more likely to see appendicitis in a 9 year old or a 29 year old than an 80 year old.  

In small, growing kids, the abdominal cavity doesn't have a lot of fat in it.  This is actually unfortunate.  The fatty material in the abdomen (called the omentum) physically stops the spread of infection when the appendix bursts.  In a 5 year old with ruptured appendicitis, the infection is everywhere.  At the time of surgery, it looks like cream of mushroom soup was poured into the abdomen along with all the intestines.

In adults, the well developed omental fat pad packs the infection into a tight space right around where the appendix lives.  At surgery, the rest of the abodminal cavity looks completely normal, but in the right lower quadrant, the fat and intestine is all stuck up to the abdominal wall.  When this is peeled down, a pocket of pus is encountered and the appendix is in the middle of it.

Little kids have a worse exposure to infection and are likely to look a bit sicker, but they don't often get critically ill from it.  Their systems are very healthy and are able to withstand the hit.  Older people may take a while longer to bounce back, but as long as they don't have other health problems, they'll typically withstand the hit also.  

People rarely die of appendicitis in the modern age, but it does happen.

When people DO die from appendicitis or other types of infection, it's because the infection gets out of control in a way that causes septic shock, and this leads to the failure of other organs like the lungs and kidneys.  Even when this type of patient is brought to the hospital, control of the infection is not going to solve all the problems.  By the time people are this sick, they need to be on a breathing machine called a ventilator and they need intensive care to try to hold them over until they recover organ functions that have been lost.  People who die after appendiceal rupture die of multi-system organ failure due to septic shock.

In the "old days", one of the puzzles was how to deal with appendicits aboard ships or even aboard submarines during war time when the mission required staying submerged.  Stories are told of ship-board medics diagnosing appendicitis and then keeping the sailor sitting upright in their bunk till the appendix ruptured, and this helped gravity hold the infection low in the pelvis.  They would let the infection mature for several days and then actually be able to feel the pus by inserting a finger into the r****m and detecting the boggy fluid pressing on the sidewall.  They would then cure the infection by popping the rectal wall with an instrument, draining the infection "trans-rectally"!  

I don't know if this actually WAS done on a submarine, but transrectal drainage of a pelvic abscess is a real treatment option in some cases.  If submarine medics knew how to do this, they were very very smart.

Even now, there are conditions that keep people from being treated for appendicitis for quite a long time and there are interesting situations that come up.

I'm a surgeon at a hospital that gets most of the patients from jails around the state.  We frequently see people who've been complaining of pain in the jails for weeks before they get brought to the hospital.  Sometimes these people actually have appendicits and it burst and caused an abscess, sometimes many days previously.  Sometimes these patients are uncomfortable, and they feel sick, but they're not dying.  Usually the abscess is a football shaped bubble of pus inside the abdomen where the appendix lives, in the right lower abdomen.  We can actually drain this pus by needling it, and then putting a drain tube into the pus so that it seeps out over a few days, while the patient recovers on antibiotics.  After the drainage stops and the patient has no more fever, we send them home (or ... to jail actually!).  They come back about 6 weeks later and we do the appendectomy operation at that time.  By waiting 4 to 6 weeks, we take a tough situation and make it into a much easier one for both the patient and the surgeon.  This is called an "interval appendectomy" because we do it after an interval of time has gone by.

The appendix is just one place in the gastrointestinal system that has a tendency to develop perforation.  There are others.  In general, the perforation of a hollow organ with bacteria inside will lead to infection of spaces that aren't as well equipped to deal with bacteria.    The worst case scenario is  

Answer 7

The percentage of people with appendicitis who have perforation at the time of surgery is substantial. Oddly, it hasn't changed since the advent of modern imaging studies.

You can google periappendiceal abscess to see the management and outcome.