Tucson - Appendicitis is the most common reason for emergency general surgery, but what causes the appendix to inflame is a medical mystery.
For more than a hundred years, it's been the routine medical treatment: the appendix gets inflamed, remove it. That practice has never been challenged until now. Research at UT Southwestern Medical Center in Dallas questions whether emergency surgery is really necessary.
"We have no idea what causes appendicitis. We have no idea why one morning, you might wake up and get appendicitis or not," said Dr. Edward Livingston.
The surgeon got curious about this common disease after operating on a patient with a ruptured appendix. "He almost died from the disease and that really struck me because he was a young healthy person who shouldn't be ill at all."
So Dr. Livingston poured over decades of hospital records, worked with an SMU economist on complex statistical methods and reached two conclusions: an inflamed appendix does not inevitably lead to a ruptured one, and a virus could be to blame for it all, setting up the possibility that antibiotics, not surgery is the best course. "We are proposing there are certain types of patients who don't need surgery, and we are about to embark on a clinical trial here to take patients who would otherwise get surgery and treat them with antibiotics alone and see how they do," he explained.
Dr. Livingston put his theory into practice with his own son. The teenage boy awoke one morning with the signs and symptoms of appendicitis. "I do this research, and my wife and I are both doctors, and we said, 'Let's just wait and watch him and see what happens,' and by morning he was fine and three years later he still has his appendix." Livingston says colleagues support his work; many have questioned surgery but did it because that's the way it's always been.
"It's the most common operation done and quite frankly, people make their living doing this, so I thought I would get slaughtered by my colleagues, but in point of fact, it's been enthusiastically received everywhere in groups of surgeons," he said. "If our study that we do this summer shows what we think it'll show, it'll be a game changer for how appendicitis is treated."
In the meantime, Livingston suggests families seek medical advice with the new understanding that it may not be as big an emergency as previously believed.