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Acute appendicitis: Epidemiology, Etiology, Pathophysiology, Clinical features, Diagnosis, Treatment
Acute appendicitis is the acute inflammation of the appendix, typically due to an obstruction of the appendiceal lumen. It is the most common cause of acute abdomen requiring emergency surgical intervention in both children and adults. The characteristic features of acute appendicitis are periumbilical abdominal pain that migrates to the right lower quadrant (RLQ), anorexia, nausea, fever, and RLQ tenderness. When seen alongside neutrophilic leukocytosis, these features are sufficient to make a clinical diagnosis using appendicitis scoring systems to estimate the likelihood of appendicitis. Imaging (e.g., abdominal CT with IV contrast, abdominal ultrasonography) may be considered if the clinical diagnosis is uncertain. The current standard of management of acute appendicitis is emergency appendectomy (laparoscopic or open) and antibiotics. Nonoperative management (NOM), which includes bowel rest, antibiotics, and analgesics, is indicated in patients with an inflammatory appendiceal mass (phlegmon) or an appendiceal abscess because the surgical intervention is associated with a higher risk of complications in these patient groups. Interval appendectomy 6-8 weeks following resolution of the acute episode may be considered in these patients to prevent a recurrence or if there is a concern for an underlying appendiceal tumor.
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