Acute appendicitis


      Appendicitis is defined as inflammation of the vermiform appendix, the most common surgical emergency in children and young adults with abdominal pain. The current standard of care for patients with appendicitis is the surgical appendicectomy, either laparoscopic or open. A non-operative strategy with antibiotics is favourable in some cases and emerging evidence suggests there could be wider applicability. Diagnosis is based on history, clinical examination and laboratory tests, although 30–45% of patients exhibit atypical signs and symptoms on presentation. Where the diagnosis remains ambiguous, ultrasound and CT scans are the most widely used imaging modalities. Diagnostic laparoscopy can be a useful approach in low-risk patients, particularly young women. Appendicitis is classified into simple or complex disease, complex in the presence of a peri-appendicular abscess, gangrene or perforation. Complex appendicitis has significantly higher rates of morbidity and mortality. Limiting the progression from simple to complex disease, although not inevitable, is the rationale for early definitive treatment. An appendicectomy performed for suspected appendicitis resulting in a normal appendix on histopathological examination is referred to as a negative appendicectomy. A negative appendicectomy has a postoperative complication rate of around 10%, demonstrating the need for both accurate and timely diagnosis.


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        • van Rossem C.C.
        • Bolmers M.D.M.
        • Schreinemacher M.H.F.
        • et al.
        Diagnosing acute appendicitis: surgery or imaging?.
        Colorectal Dis. 2016; 18: 1129-1132
        • Faiz O.
        • Clark J.
        • Brown T.
        • et al.
        Traditional and laparoscopic appendectomy in adults. Outcomes in English NHS hospitals between 1996 and 2006.
        Ann Surg. 2008; 248: 800-806
      1. McCarty AC. History of appendicitis vermiformis its diseases and treatment. University of Louisville 1927. Presented to the Innominate Society.

        • Machado N.N.
        • Machado N.O.
        Neurogenic appendicopathy: a historical and contemporary review.
        World J Colorectal Surg. 2014; 4 (Art 1)
        • Kooij I.A.
        • Sahami S.
        • Meijer S.L.
        • et al.
        The immunology of the vermiform appendix: a review of the literature.
        Clin Exp Immunol. 2016; 186: 1-9
        • Bhangu A.
        • Søreide K.
        • Di Saverio S.
        • et al.
        Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management.
        Lancet. 2015; 386: 1278-1287
        • Drake F.
        • Mottey N.E.
        • Farrokhi E.T.
        • et al.
        Time to appendectomy and risk of perforation in acute appendicitis.
        JAMA Surg. 2014; 149: 837-844
        • Ashdown H.
        • D'Souza N.
        • Karim D.
        • et al.
        Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study.
        BMJ. 2012; 345: e8012
        • Abbasi N.
        • Patenaude V.
        • Abenhaim H.
        Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases.
        BJOG. 2014; 121: 1509-1514
        • Silvestri M.
        • Pettker C.
        • Brousseau E.
        • Dick M.
        • Ciarleglio M.
        • Erekson E.
        Morbidity of appendectomy and cholecystectomy in pregnant and nonpregnant women.
        Obstet Gynecol. 2011; 118: 1261-1270
        • Thompson M.M.
        • Underwood M.J.
        • Dookeran K.A.
        • et al.
        Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis.
        Br J Surg. 1992; 79: 822-824
        • Strong S.
        • Blencowe N.
        • Bhangu A.
        National Surgical Research Collaborative. How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study.
        Int J Surg. 2015; 15: 107-112
        • Connor S.J.
        • Hanna G.B.
        • Frizelle F.A.
        Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies.
        Dis Colon Rectum. 1998; 41: 75-80
        • Blake L.
        • Som R.
        Best evidence topic: what is the best management of the appendix-stump in acute appendicitis: simple ligation or stump invagination?.
        Int J Surg. 2015; 24: 20-23
        • Bhangu A.
        • Richardson C.
        • Torrance A.
        • et al.
        National Surgical Research Collaborative. Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy.
        Br J Surg. 2013; 100: 1240-1252