To Cut or Not To Cut

Can the body heal acute appendicitis?

The pain starts slow. You first feel it near your belly button. Over the day it gets worse and worse. Now the pain is in your right lower abdomen? It’s getting worse. You’re getting sick and have a fever. You rush to the Emergency Room and find out it’s your appendix.

Next thing you know, a surgeon, a nurse, and 3 residents are standing over you asking a million questions while they poke at your tender belly. The rest is a blur but you wake up with less pain and 3 ugly scars on your abdomen.

This story is all too common in Western Medicine. The appendix always gets a bad rap. It’s called a “vestigial organ” which serves no purpose any longer. It causes problems once and some doctor with a fancy knife wants to cut it out.

Call me crazy, but I think there’s a better way to handle it. Before we get into that, let’s go over what the appendix actually is.

The appendix is a small bling-ended tube hanging off the first part of your large bowel known as the cecum (most of the time). It is surrounded by lymphoid tissue which is part of the mucosal immune system. When bacteria, viruses, toxins, and so forth contact the mucosal tissues, they trigger an immune response.

This immune response is critical for maintaining normal gut function and gut microflora. Long story short, it helps maintain the healthy bacteria and function of the gut.

It is not simply a useless vestigial organ as many physicians and surgeons will tell you. If they still believe that, they are at least a decade behind on the science and you probably don’t want them cutting into you.

The main concern when it comes to the appendix is acute appendicitis. As the name suggests, this is inflammation and often infection of the appendix. This may be due to a small stone or entrapped stool or damaged gut mucosa. Regardless, it all presents the same way.

Most of the time you start feeling sick. You get a fever, mild abdominal pain, diarrhea or constipation, and some nausea.

Pain starts around the belly button. This is due to embryologic reasons we don’t need to get into. As it gets worse and the inflammation gets worse, the lining of the abdomen (peritoneum) becomes inflamed. This causes the pain to shift to the right lower quadrant of the abdomen aka McBurney point.

The inflammation in the peritoneum also provides a good way to diagnose acute appendicitis through a physical exam. Skilled physicians can easily localize the cause of pain through a physical exam. Rebound tenderness is one example. When they apply deep pressure to the abdomen and then suddenly let go, patients with peritonitis will feel it. Trust me.

Over time the appendix may cause pain in other locations, depending on where exactly it is located in the body. If it’s more posterior they may be able to detect retroperitoneal pain (Rosving sign). If it’s more anterior they may be able to detect pain by asking the patient to extend their leg behind their back (psoas sign). There are many little tricks like this.

Since most ED doctors, or physicians generally, don’t have strong physical exam skills, they rely on diagnostic imaging. This is often done with an ultrasound or CT scan of the abdomen. Most of the time this is an easy diagnosis with either method.

Okay, so you’ve been diagnosed. What’s next? Modern medicine says surgery is the only definitive solution. But there are caveats.

If appendicitis has been going on for too long the surgeon may choose to give it time to “cool down.” The reason for this is the tissue becomes very fragile when it’s acutely inflamed. When they try to grab it with their tools it rips like a wet paper towel (I have personally seen this. It is not fun.). Giving the body a few days to knock down inflammation makes the surgery easier and reduces complications.

If patients aren’t healthy enough for surgery, and the anesthesia required, they may decline to operate entirely. It may very well be safer to avoid surgery than it is to put someone under anesthesia who might not wake up. The surgeons do not like having people die on the operating table.

The alternative to surgery, as you might expect, is the body’s natural healing ability. Turns out, your body had it figured out a long time ago.