Also I have many experience in such condition. Laparoscopic appendectomy with drainage and then conservative was always sucessful in my cases.
Laparoscopic appendectomy with postoperatively drainage and good hemostasis, worked allways for me in the past. Clopidogrel works for 10 days. So acute operations (incarcerated hernia, perforations of stomach, colon,...), can't wait for 10 days. Minimal invasiv operations with excellent hemostasis are succesfull for me.
I will wait for 3-5 days stopping clopidogrel and see the progress. If OK, I will discontinue clopidogrel for another 4-5 days. If ok I will proceed with interval appendicectomy. If the condition of patient worsen I may have to operate at least after 5-7 days of stopping clopidogrel.
Early appendectomy and excellent hemostasis. You can't wait the antiplatelet wash-out for two reasons. 1) Cardiologist guidelines suggest don't stop double antiaggregation. 2) More relevant, You can't wait so much time before surgery, the risk of septic complications is too high
If CABG has been done within 1 year then double drug should be continued but after 1 year, stopping clopidogrel may be done for short period if absolutely essential. In presence of both drugs, risk of unstoppable hemorrhage is high in the convalescence period since the bleed will be from capillaries. This may bring in another mortality risk while trying to aviod another. But i do agree the situation is dicey and one has to consider expertise and available resources in hospital for any decision.
Immediate laparoscopic appendicectomy,wash out and drainage.
Excellent heamostasis is crucial.
Delaying a patient for days may results in disastrous complications.Having said that, conservative treatment and delayed/elective appendicectomy is another option.This needs to be consultated with the patient and if patient doesn't want immediate surgery ,then active monitering is warranted.If the patient develop signs of deterioration/sepsis/increased inflammatory markers,then immediate surgrey is the only option.
Dear Doctor Gautam Ray,
maybe you can stop the antiplatelets drugs, but if you don't wait the wash-out time (7-10 days), and early operate the patient, this one will be in completely antiaggregation and will bleed like if you have not stopped antiplatelets drugs. The only way to reduce bleeding is waiting the wash-out time, but keep in mind that the patient will have many possibility to stop bleeding forever because a delayed appendectomy in a perforated appendicitis can lead quite easy toward a septic shock.
Dear Dr. Vasquez,
I agree, but since it is a localised perforaton many of which are known to seal off with conservative treatment. a short wait with close monitoring may be considered for this situation which is like two edged sword.
Dear Doctor Gautam Ray,
Perforation in acute appendicitis represent the complication of the complication. I believe in Santa Claus and Spiderman but i can't believe that a perforated acute appendicitis can heal by itself only with the use of antibiotics. Excuse my skepticism, but I talk as acute case surgeon, which I am