How is Ruptured Appendicitis treated? - Dr. Nagaraj B. Puttaswamy

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Acute appendicitis is otherwise a common condition seen in teenage children, but we have seen patients from say age of 2 years too say age of 80 - 90 years. But if it is diagnosed early and treated early by a conventional surgery or a laparoscopic surgical procedure, it becomes a simpler surgical procedure. But appendicitis if not addressed properly can go on and produce life threatening complications in the form of appendicular abscess, appendicular mass, or rarely rupture of appendix. Rupture of appendix will cause gross peritonitis, that is infective material will get into the peritoneal cavity or the abdominal cavity and that can cause significant amount of pain abdomen, which is diffuse, that can cause significant amount of pain abdomen, which was otherwise located in the right ileac fossa, the pain will get presented through the abdomen. Once that develops, the child will develops severe pain abdomen and difficulty to breathe and high temperature, and all this will set in and the sepsis is intense, the blood pressure may intensely fall because of sepsis and the child has to be admitted immediately and planned how to do an emergency procedure. Even here there is always a possibility of laparoscopic appendectomy provided it is done in safe hands. But the diagnosis of ruptured appendicitis is done on clinical diagnosis and parallel we back up with blood investigations and ultrasound scan and also CT scan which will reveal fluid collection in the peritoneal cavity which is turbid, suggestive of peritonitis. This will tell you the diagnosis of ruptured appendicitis and it has to be done with the help of laparoscopy. Diagnostive laparoscopy will be showing us significant amount of fluid collection which is infective and the target organ is appendix and the target organ is ligated at the base of the appendix, do a piece meal appendicectomy if it is very badly ruptured and then give a thorough and we may leave a tube drain in the abdominal cavity to drain out the infective focus backing up with good amount of antibiotics which are usually sensitive.