What are the contraindications for surgery in acute appendicitis?

Generally, contraindications for surgery in acute appendicitis mainly include severe cardiopulmonary insufficiency, acute diffuse peritonitis with septic shock, coagulation disorders, severe hepatic or renal failure, and late pregnancy. The details are as follows:

1. Severe cardiopulmonary insufficiency: Patients with conditions such as severe heart failure, acute myocardial infarction, or severe pneumonia may have cardiopulmonary functions too compromised to tolerate surgical trauma and anesthesia. Proceeding with surgery under these circumstances could trigger cardiopulmonary failure. These patients should first receive medical treatment to improve cardiac and pulmonary function; surgery may be considered only after vital signs have stabilized.

2. Acute diffuse peritonitis with septic shock: When perforation from acute appendicitis leads to diffuse peritonitis and the patient develops symptoms of septic shock—such as a sudden drop in blood pressure, altered mental status, and cold, clammy extremities—anti-shock measures must be initiated immediately. These include rapid fluid resuscitation, potent anti-infective therapy, and correction of electrolyte imbalances before surgical intervention can be considered.

3. Coagulation disorders: Patients with abnormal coagulation due to hematologic diseases or long-term anticoagulant use are at high risk of massive intraoperative bleeding and poor postoperative wound healing. Coagulation function should first be corrected through transfusion of clotting factors or adjustment of anticoagulant medications. Surgery should be delayed until coagulation parameters are within acceptable ranges.

4. Severe hepatic or renal failure: In patients with acute liver or kidney failure, metabolic and detoxification capacities are severely impaired. Surgery may further compromise organ function and increase the risk of postoperative infections. Treatment strategies such as dialysis or hepatoprotective therapies should be used to improve organ function prior to evaluating the appropriate timing for surgery.

5. Late pregnancy: In the late stages of pregnancy, the fetus is nearly full-term, and surgical procedures may stimulate uterine contractions, potentially triggering preterm labor. If appendicitis symptoms are mild, initial management may involve anti-infective therapy to control inflammation. Appendectomy can be deferred until after delivery when the fetus is full-term.

In clinical practice, decisions must be made based on a comprehensive assessment of the individual patient's condition. Treatment strategies with lower risks should be prioritized, ensuring patient safety while effectively managing symptoms caused by acute appendicitis.