Appendicitis
Appendicitis is inflammation of the appendix.[2] Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite.[2] However, approximately 40% of people do not have these typical symptoms.[2] Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis.[3]
Appendicitis
Epityphlitis[1]
Periumbilical or right lower abdominal pain, vomiting, decreased appetite[2]
Based on symptoms, medical imaging, blood tests[4]
11.6 million (2015)[8]
50,100 (2015)[9]
Appendicitis is primarily caused by a blockage of the hollow portion in the appendix.[10] This blockage typically results from a fecaloma, a calcified "stone" made of feces.[6] Other factors such as inflamed lymphoid tissue from a viral infection, intestinal parasites, gallstone, or tumors may also lead to this blockage.[6] When the appendix becomes blocked, it experiences increased pressure, reduced blood flow, and bacterial growth, resulting in inflammation.[6][11] This combination of factors causes tissue injury and, ultimately, tissue death.[12] If this process is left untreated, it can lead to the appendix rupturing, which releases bacteria into the abdominal cavity, potentially leading to severe complications.[12][13]
The diagnosis of appendicitis is largely based on the person's signs and symptoms.[11] In cases where the diagnosis is unclear, close observation, medical imaging, and laboratory tests can be helpful.[4] The two most commonly used imaging tests for diagnosing appendicitis are ultrasound and computed tomography (CT scan).[4] CT scan is more accurate than ultrasound in detecting acute appendicitis.[14] However, ultrasound may be preferred as the first imaging test in children and pregnant women because of the risks associated with radiation exposure from CT scans.[4] Although ultrasound may aid in diagnosis, its main role in identifying important differentials, such as ovarian pathology in females or mesenteric adenitis in children.
The standard treatment for acute appendicitis involves the surgical removal of the inflamed appendix.[6][11] This procedure can be performed either through an open incision in the abdomen (laparotomy) or using minimally invasive techniques with small incisions and cameras (laparoscopy). Surgery is essential to reduce the risk of complications or potential death associated with the rupture of the appendix.[3] Antibiotics may be equally effective in certain cases of non-ruptured appendicitis.[15][7][16] It is one of the most common and significant causes of sudden abdominal pain. In 2015, approximately 11.6 million cases of appendicitis were reported, resulting in around 50,100 deaths worldwide.[8][9] In the United States, appendicitis is one of the most common causes of sudden abdominal pain requiring surgery.[2] Annually, more than 300,000 individuals in the United States undergo surgical removal of their appendix.[17] Reginald Fitz is credited with being the first person to describe the condition in 1886.[18]
Prognosis[edit]
Most people with appendicitis recover quickly after surgical treatment, but complications can occur if treatment is delayed or if peritonitis occurs. Recovery time depends on age, condition, complications, and other circumstances, including the amount of alcohol consumption, but usually is between 10 and 28 days. For young children (around ten years old), the recovery takes three weeks.
The possibility of peritonitis is the reason why acute appendicitis warrants rapid evaluation and treatment. People with suspected appendicitis may have to undergo a medical evacuation. Appendectomies have occasionally been performed in emergency conditions (i.e., not in a proper hospital) when a timely medical evacuation was impossible.
Typical acute appendicitis responds quickly to appendectomy and occasionally will resolve spontaneously. If appendicitis resolves spontaneously, it remains controversial whether an elective interval appendectomy should be performed to prevent a recurrent episode of appendicitis. Atypical appendicitis (associated with suppurative appendicitis) is more challenging to diagnose and is more apt to be complicated even when operated early. In either condition, prompt diagnosis and appendectomy yield the best results with full recovery in two to four weeks usually. Mortality and severe complications are unusual but do occur, especially if peritonitis persists and is untreated.
Another entity known as the appendicular lump is talked about. It happens when the appendix is not removed early during infection, and omentum and intestine adhere to it, forming a palpable lump. During this period, surgery is risky unless there is pus formation evident by fever and toxicity or by ultrasound. Medical management treats the condition.
An unusual complication of an appendectomy is "stump appendicitis": inflammation occurs in the remnant appendiceal stump left after a prior incomplete appendectomy.[96] Stump appendicitis can occur months to years after initial appendectomy and can be identified with imaging modalities such as ultrasound.[97]