“Late Show” host Stephen Colbert cancelled this week’s episodes while he recovers from an appendectomy, he announced on Threads.
“Going forward, all emails to my appendix will be handled by my pancreas,” the comedian wrote in the post.
For perspective on Colbert’s condition — which the host described as a “ruptured appendix” — MedPage Today spoke with David Flum, MD, MPH, a surgeon at the University of Washington in Seattle, who has led recent research efforts on treatment of appendicitis.
The appendix is only the size of a pinky finger, but when inflamed, it can start rubbing against the lining of the stomach on the right side, which is where most people start to feel pain, Flum said. Appendicitis symptoms can also start as generalized pain around the belly button and then intensify towards the right side. Some people even lose their appetite.
Flum noted the common phrase “burst appendix” is technically a perforated or ruptured appendix. However, appendicitis doesn’t always involve a rupture — sometimes it’s just inflammation, he said.
“If the inflammation is particularly bad, or the type of bacteria you have in your appendix is a particular type, a break in the wall of the appendix can happen and you can start spilling pus and bacteria into the into the surrounding area,” Flum explained. “That’s what we call a ‘burst’ appendix.”
Colbert had surgery for his ruptured appendix, but more studies in recent years have focused on whether appendicitis — even when a perforation is involved — can be managed with antibiotics.
Indeed, Flum led the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which found that antibiotics were noninferior to appendectomy by a standard 30-day quality-of-life score. People who took antibiotics also got back to work twice as fast as people who had surgery, Flum said.
However, longer-term follow-up from the study revealed that nearly half of patients had to have their appendix surgically removed by year 2.
Both treatment strategies have pros and cons, Flum said: “One treatment is not better than the other.”
The upside to antibiotics is avoiding surgery, which many patients prefer, especially if they need to get back to work or caregiving promptly. But the trade-off is the risk of developing appendicitis again down the line, Flum said. With appendectomy, it’s “one and done,” Flum said. “You’re there, you’re sick, you get your appendix out, then you never have to worry about your appendix ever again.”
He said the vast majority of appendicitis patients who go to the hospital will get an appendectomy in part because it’s been the go-to treatment for ages.
Yet a perforated appendix can still be treated with antibiotics in many cases, Flum said.
“I think there’s a misconception that antibiotics only work for people with the earliest appendicitis, or what’s called uncomplicated appendicitis, in part that’s because the earliest studies carefully selected patients to make sure that they didn’t include people with perforation or burst appendices,” Flum said, adding that the CODA trial did indeed include these patients.
However, no doctor would even consider antibiotics in the rare case of severe appendicitis where an abscess develops and drains, he said. Surgery would be the best option for these cases.
Ultimately, Flum said appendectomy or antibiotics “should be a decision made in an informed way by patients. It’s not really for us to decide for them.”
Flum pointed healthcare practitioners to a decision tool developed by the Treatment Individualized Appendicitis Decision Making (TRIAD) program at the University of Washington to help determine whether a given patient needs an appendectomy or can be treated with antibiotics instead.
Between 5% and 9% of people will get appendicitis in their lifetime, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Although people in their 20s and teens are most likely to develop it, appendicitis can happen at any age.
This isn’t the first time Colbert has cancelled shows this year. Last month, he had to cancel several episodes when he got COVID.