Diagnosed with Appendicitis but Sent Home Untreated

[Deactivated] on 15/10/2019 - 21:47

Yesterday I was rushed to a public hospital emergency room after extreme headache, abdominal pain, fever, shivering, low blood pressure, vomiting etc.

The doctors suspected a viral infection but all blood/urine tests came out negative. In between the tests I was given painkillers and 3 litres of electrolyte solution (through the vein), which helped all the symptoms to go away by morning.

However, just before being discharged I asked for a CT because I had a history of kidney pains and the CT showed the appendix was larger than normal (13 mm). From what I read in the internet the normal size could be as low as 6 mm.

But, the doctors said because the symptoms are no longer there we don't operate it and you should come back if it got worse. Interestingly, the discharge letter says:

Diagnosis: Appendicitis - Acute

This all confuses me. Should I wait until it bursts in another pain episode?

Is there a way that I can get this looked at quicker, perhaps through a GP referral?

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Comments

  • datafellows on 15/10/2019 - 22:12
    +3

    This is not medical advice and I am not qualified in anyway in these matters but if you are concerned or have pain in your lower right side of your stomach where the appendix is located with or without pressing with your fingers go to see another doctor.

    I had my appendix removed while I was on holidays, it did not burst but the pain was unbelievable and was wheeled to operation theatre in a wheelchair for immediate surgery.

    And no, you should not wait until it bursts as it is life threatening if it does so.

    • fossilfuel on 15/10/2019 - 22:22
      +1

      I had a similar experience. Not appendicitis but horrible abdominal pain. Went to ED and the ED doctors asked the surgical team for further assessment to see if it was necessary to do an operation.

      Appendicitis is very serious. I would go to the ED at a larger hospital as they might have better equipment, facilities and more staff. You can check in with your GP but most likely they will tell you to go to ED immediately if you have appendicitis.

    • dcep on 15/10/2019 - 22:31

      what cause it ?

      • datafellows on 16/10/2019 - 17:50
        +1

        It's caused by a blockade in your "internal piping" as the appendix itself is a dead end.

        I had an awesome buffet dinner at a cruise few days before any symptoms and during midnight I had sharp pain in my stomach which woke me up. I slept till morning and went to see GP who told me to go directly to hospital.

        I was quite lucky as I was in operating room counting backwards from 100 just 15 minutes after arriving to hospital :D

  • chumlee on 15/10/2019 - 22:16
    +1

    Go see Dr Nick

  • DiLs on 15/10/2019 - 22:57
    -2

    wait for it to bursrt and then sue the hospital for large sums of money

  • paraneoplastic on 15/10/2019 - 22:58
    +2

    Can i ask what age bracket you are in? Since you mentioned kidney stones i'm guessing 30 + ?

    you mentioned you where put on hartmans/ringers lactate ('electroylte solution'), were you also put on antibiotics?

    I'm sure the ED docs had good reasoning for why they discharged as no one wants to do their patients any harm or put them at risk

    • [Deactivated] on 16/10/2019 - 01:24

      Aged 42, the 'appendicitis diagnosis' did not occur until after about 16 hours that I had arrived there (an incidental finding of CT).

      Immediately after diagnosis, I was put on 50 ml or so of antibiotics by one doctor (who diagnosed the appendicitis) and was told to be ready for surgery.

      But, surgical doctors came (in a matter of an hour) and said no surgery is required. Still got the diagnosis letter though.

      It is now more a matter of leave it or do more about it now because if it is to come back again, it's likely to be much worse (given the size anomaly).

      • paraneoplastic on 16/10/2019 - 01:32
        +1

        I see, and you weren't given a script for any oral antibiotics to continue on, particularly cefazolin or similar?

        The edema should decrease so the size anomaly you mention will rapidly decrease, however if your a concerned enough, it'd definetely be worthwile going to your GP and raising your concerns, as they are valid (at least that way you have a port of call) also if you have private healthcare you can always get it done privately.

        • [Deactivated] on 16/10/2019 - 01:40

          No antibiotics to take out of hospital. The one in hospital had been 2g of IV ceftriaxone. That's why I should go see a GP.

  • Nashraf on 15/10/2019 - 23:02

    Hi..
    Not all appendicitis needs to be treated surgically. A large proportion of them respond to fluids and antibiotics. So from a risk-benefit analysis , it makes sense to be conservative. There are real risks to surgery and anaesthesia aren’t there? Also, the postoperative pain, risk of infections In the postop, days out of work etc need to be considered.
    Even medical literature is kinda equivocal about the surgical vs nonsurgical (wait and watch)approaches. So it ultimately boils down to local surgical protocols

    Yes, so this does mean that if you have recurring symptoms you will need to go in again.
    Hope this helped. Hope you are better

    • paraneoplastic on 15/10/2019 - 23:19
      +1

      Can you support your statement that a large proportion respond to abx and fluids? (not trying to have a go at you genuinely curious)

      the best study i could find which was a meta-analysis disagrees

      https://www.karger.com/Article/FullText/324595

      From my limited time in general surgery and ED out of the 9 or 10 AA patients i saw, all underwent surgery

      • Nashraf on 15/10/2019 - 23:42

        Sure..I read up on UpToDate. Although the authors of the article say that its their personal preference that they would go for surgery

      • tebbybabes on 16/10/2019 - 02:27
        +1

        A few decades ago a wise MD once told me that a confirmed acute appendicitis REQUIRED surgical management. Nowadays, my wife, who is still practicing, tells me that there are a good portion of cases that are now managed conservatively. Boggled my mind when she told me as it was completely contradictory to how I was trained.

        Just sharing. Since I have no evidence to present, it's all anecdotal from me.

        • paraneoplastic on 16/10/2019 - 08:26
          +1

          Even anecdotally I find that really strange, I’ve seen it occur once as a medical student years ago at a under funded hospital but I’ve always been under the impression that in tertiary centres surg was the way to go.

          Thanks for sharing :)

          • [Deactivated] on 16/10/2019 - 15:11

            @paraneoplastic: I have a feeling this is going to proverbially and literally blow up in our collective faces.

            Fantastic if we can manage a problem but seeing as how appendectomies are practically routine, what school of thought would suggest management over elimination?

            It's all good to say that it is minimally invasive and traumatic for the patient but I'd rather minimally invade and traumatize a 40 year old than an 80 year old.

      • [Deactivated] on 16/10/2019 - 16:34
        +1

        • Anecdotal reports describe the success of IV antibiotics in treating acute appendicitis in patients without access to surgical intervention (eg, submariners, individuals on ships at sea..etc).

        • In a prospective study of 20 patients with ultrasonography-proven appendicitis, symptoms resolved in 95% of patients receiving antibiotics alone, but 37% of these patients had recurrent appendicitis within 14 months.

        • The Appendicitis Acuta trial, which compared antibiotic therapy with appendectomy in the treatment of 530 patients with uncomplicated acute appendicitis confirmed by computed tomography (CT), was not able to demonstrate noninferiority of antimicrobial management versus surgery.

        That being said, even if the management of patients with an appendiceal mass is possible, appendectomy remains the only curative treatment of appendicitis. Why not have it done privately if you have health insurance?

        Disclaimer: Not that kind of doctor. My OCD wouldn't have been able to cope with rummaging inside people's entrails day-in and day-out 🤮

        • [Deactivated] on 16/10/2019 - 21:52

          private health insurance

          is a curious thing in Australia. Let's assume that a hospital charges no more than Medicare scheduled fees. For a $4000 medical bill, Medicare will pay $3000 (75%) and private health insurance pays the rest $1000 (25%). However, most insurance plans have an excess that in my case was $750. Even if I was being treated in a private hospital, the private insurance would need to pay only $250 of the $4k bill. That is even less than 2 months premium!

        • [Deactivated] on 17/10/2019 - 15:07

          rummaging inside people's entrails day-in and day-out

          Hate to break it to you but it's nothing close to that level of excitement.

          It's closer to harvesting a small tomato through a camera.

  • Clear on 15/10/2019 - 23:03

    If it was me I'd take that discharge letter and go to another hospital (if possible) or to the GP and get a second opinion. Why would they say acute appendicitis but send you home because the symptoms are no longer there?

    I work in the industry and all doctors I know say the only treatment is surgery and antibiotics aren't a permanent fix. Of course that's up to debate though!

    Speaking from experience I had my appendix out earlier this year after my blood results came back positive for appendicitis. After about 15 hours of abdominal pain it stopped and I felt completely fine. The following afternoon it burst however and everything went downhill from there.

    • [Deactivated] on 16/10/2019 - 01:28

      That is frightening. Hope you are well now.

      • Clear on 16/10/2019 - 07:37
        +1

        Fortunately the complications were minimal and the hardest part was trying to get up when lying down. All good now with a few scars left over from the keyhole surgery.

        Since I didn't know your appendix isn't inflamed as you mentioned below. Best to see your GP rather than another hospital just to be certain. I know a lot of OzBargainers hate second opinions here for some reason but it's better to be safe than sorry :)

  • Noragrets on 16/10/2019 - 00:30
    +1

    I had exactly the same in February.
    I had excruciating pain which lasted probably 8 hours and then gradually went away. I went to my GP who referred me to get an ultrasound. When I had that done the technician sent me straight to hospital as I had appendicitis. I was admitted and told I was having surgery that night, and then it kept being delayed. 4 days in hospital being starved for surgery for them to send me home and tell me I'm fine. I went back to my doctor who told me I had reoccurring appendicitis and that one day it will probably burst but for now I'm okay. I kept having pains so I ended up seeing 3 more doctors and a surgeon who all dismissed me because after 5 or so hours the pain would ease. I havent had pain in probably 4 months now but for a period of time I was stuck on the couch in agony and no one wanted to help.

  • H E B on 16/10/2019 - 00:57

    Guidelines will differ based on state, hospital, access to theatre but for me most importantly weighing up whether appendix likely to burst as that's the complication I want to avoid the most.

    Modern research is now leaning towards not necessarily taking it out and treating with antibiotics if ok compared to the historical view of just taking it out on the safe side. If it's looking fairly uncomplicated it may be towards 40% likely as to reoccurring inflammation in the short term.

    If the pain suddenly worsens to sharp pain coupled with nausea get yourself back to the ER immediately. Otherwise keep your fingers cross the antibiotics and time will do its thing!

    • [Deactivated] on 16/10/2019 - 01:34

      I probably go to GP to at least get antibiotics. One of the reasons the ED gave for no surgery was that although it is large, there is no evidence of inflammation. They then disassociate all pain and other symptoms as being for an unknown reason. So, the diagnosis was based on the size of the appendix and a moderate level of pain in that area (after it had been subdued for 16 hours).

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