How often has anyone had their ER patient have a ruptured appy and NOT go to the OR? I had a patient with a ruptured appy who was very upset, as was the whole family and was not going to the OR.
The rationale, I'm told, is a "wait and see" approach where they're given antibiotics and are monitored for about a week. I understand that since it has ruptured, the contents (in theory) should reabsorb and perhaps wall off, but the reoccurrence of appendicitis is there in the future. People die of a ruptured appendix, I'm not understanding the simple answer here. How in this day and age, when surgery residents are gung ho to go in and operate, why they would want to NOT go in on this? The chance of overwhelming infection with a perf'd appendix seems worth the risk to me.
I wondered if there was some new literature out there that I might not know about, and as per my usual, I offered the family to ask those questions they have (even after the surgery team spent a great deal of time with them). I'm sure the trauma/surgery chief and attending will see them, as the residents spent so much time and the patient and family were so unhappy about this conservative approach.
I've been doing this a fair amount of time, and not that I know everything or anywhere near everything, but a ruptured appy has always been taken to the OR in my experience until this point. There must be more to the story with this patient. It's fascinating, but my instinct and knowing the risks of Peritonitis and further complications (fecal ball also in there with this patient), how can a "conservative" approach be safer for this patient than the OR?
She had no medical problems, no meds, no allergies. VS had been stable, but she started to look TERRIBLE in the 3 or 4 hours we were with her....
Would love to hear what you all have to write.