APPENDICITIS CASE PRESENTATION

MANAGEMENT

Management of appendicitis according to Mansjoer, 2000

BEFORE SURGERY

 Installation of stomach probes for decompression

 Installation of catheter to control urine production
 Rehydration
 Antibiotic with broad-spectrum, high doses and administered intravenously.
 Drugs for fever, Phenergan as anti-chills, largactil to open vessels – peripheral vascular given
after rehydration reached.
 When there is a fever, it should be lowered before given anesthesia

OPERATIONS

 Appendectomy: An appendectomy, also termed appendicectomy, is a surgical operation in

which the vermiform appendix is removed. Appendectomy is normally performed as an urgent
or emergency procedure to treat complicated acute appendicitis. Appendectomy may be
performed laparoscopically or as an open operation.
 Appendix discarded, if the appendix is perforated freely, the abdomen was washed with saline
and antibiotics.
 Appendix abscess treated with antibiotics IV, it’s mass may shrink, or abscess may require
drainage within a few days. Appendectomy is done if the abscess elective surgery performed
after six weeks to three months.

POST-OPERATIVE

 Observation TTV
 Raise the sonde stomach when the patient has been unconscious so that aspiration of gastric
fluid can be prevented
 Place the patient in semi-fowler position
The patient is said to be good if in 12 hours without any disturbance during patient fasted.
 Provide drink starting from 15ml/hour for 4-5 hours then raise to 30ml/hour. Give soft food
the next day as tolerated.
 One day post-surgery patients are encouraged to sit up in bed for 2x in 30 minutes.
 On the second day the patients are encouraged to stand and sit outside the room.
 Day 7 stitches can be removed, and the patient allowed to go home.

In appendix mass state with an active inflammatory process that is still characterized by:

 The general state of the client still looks sick, the body temperature remains high
 Local examination in the lower right quadrant of the abdomen still shows signs of peritonitis.
 In this case, surgery should be performed as soon as the client is prepared, because of concern will
occur appendix abscess and generalized peritonitis. Preparation and the surgery must be done as
soon as possible given the complications of wound infection is more higher than surgery risks in
simple appendicitis without perforation.

In the state of appendix mass with inflammatory processes that have eased characterized by:

 Generally, clients aged 5 years or more

 The general situation has improved with no visible ill, the body temperature is not high
anymore
 Local examination of the abdomen shows no sign of peritonitis and only palpable mass with
clear and mild tenderness.
 Laboratory leukocyte count and differential count is normal.

The action taken should be conservative with antibiotics and bed rest. If surgery done, there will more
difficulties and more bleeding, therefore when the mass of the appendix has formed more than a week
since the attack of stomach pain, surgery is done immediately when the treatment occurs abscesses
with or without generalized peritonitis.