Acute appendicitis is one of the most common causes of emergency abdominal surgery worldwide. It is a medical emergency that, if untreated, can lead to serious complications like rupture, peritonitis, or abscess formation. This article offers an in-depth, humanized, and medically accurate overview of acute appendicitis — from its causes and clinical features to investigations, differential diagnoses, treatment strategies, and prognosis.
What is Acute Appendicitis?
Acute appendicitis is defined as inflammation of the vermiform appendix, a narrow, finger-like pouch attached to the large intestine. While its exact function remains debatable, inflammation of this small organ can quickly lead to severe complications, necessitating timely diagnosis and intervention.
Why is Appendicitis Important?
- Most common abdominal surgical emergency
- Occurs across all age groups but more common in children, teens, and young adults
- Prompt treatment can prevent life-threatening complications
- Has a high recovery rate if addressed early
Key Features of Acute Appendicitis
- Most patients present with right lower abdominal pain
- Initial pain is often peri-umbilical before localizing to right iliac fossa (RIF)
- Associated with nausea, vomiting, low-grade fever, and loss of appetite
- If untreated, can lead to gangrene, rupture, abscess, or generalized peritonitis
Epidemiology
- Worldwide prevalence: Very common in Western countries
- Bimodal age distribution:
- First peak in second decade of life
- Second, less frequent peak in elderly patients
- More common in males
- Risk factors include low-fiber diets, obesity, and family history
Causes and Pathogenesis
Types of Appendicitis:
1. Obstructive (most common):
Blockage of the appendiceal lumen by:
- Fecoliths (hardened stool)
- Lymphoid hyperplasia (common in children)
- Tumors
- Parasites
Clinical Features
Symptoms usually develop rapidly over 24–48 hours and may include:
- Abdominal pain:
- Begins around the umbilicus and migrates to right lower quadrant
- Worsens with movement, coughing
- Nausea and vomiting
- Low-grade fever (mild pyrexia)
- Anorexia (loss of appetite)
- Constipation or diarrhea
- Localized tenderness over McBurney’s point
- Rebound tenderness and guarding
In late presenters (>5 days), signs of complications like appendix mass or peritonitis may be seen.
Differential Diagnosis
Gastrointestinal:
- Cholecystitis
- Perforated duodenal ulcer
- Pancreatitis
- Mesenteric adenitis
- Small bowel ischemia
- Crohn’s disease (ileal)
- Salmonella typhlitis
- Perforated colon carcinoma
- Ileal tuberculosis
- Diverticulitis
Other Abdominal:
- Renal colic
- Pyelonephritis
- Ovarian cyst
- Ectopic pregnancy
- Pelvic Inflammatory Disease (PID)
Extra-abdominal:
- Right lower lobe pneumonia
- Herpes zoster
- Diabetic ketoacidosis
- Acute intermittent porphyria
Investigations
Although appendicitis is largely a clinical diagnosis, investigations help confirm or rule out other conditions.
Laboratory Tests:
- White Blood Cell Count (WBC): Often raised
- C-Reactive Protein (CRP): Elevated in inflammation
- Urinalysis: Rule out urinary infections or renal stones
- Pregnancy test: In females to exclude ectopic pregnancy
Imaging:
- Ultrasound: Useful in children and young women; may show inflamed appendix or pelvic pathology
- CT Scan: Most accurate in diagnosing appendicitis (sensitivity >90%)
- MRI: Occasionally used in pregnancy
- Laparoscopy: Both diagnostic and therapeutic
Complications of Untreated Appendicitis
- Perforation: Leads to peritonitis and sepsis
- Abscess: Pelvic, subphrenic, or right iliac fossa
- Appendix mass (phlegmon): Inflamed appendix with surrounding tissue inflammation
- Adhesions: May lead to bowel obstruction
- Portal pyemia: Rare but serious liver complication
- Wound infection: Post-surgical
Management and Treatment
Initial Stabilization
- IV fluids
- Analgesics
- Nil by mouth (NPO)
- Broad-spectrum antibiotics
Surgical Treatment
1. Appendectomy (Gold Standard)
- Laparoscopic (preferred): Less pain, faster recovery
- Open surgery: Reserved for complicated cases or abscess drainage
2. Interval Appendectomy
- For patients with resolved appendicular mass
- Surgery done 6–8 weeks later
- Increasing trend toward conservative management unless recurrence
Non-Operative Management
In select cases (early or uncomplicated):
- IV antibiotics
- Close monitoring
- Reserved for high-risk patients or those refusing surgery
Post-Operative Care
- Monitor for wound infection
- Early ambulation
- Gradual resumption of oral intake
- Discharge typically within 24–48 hours (laparoscopy)
Prevention of Appendicitis
There is no guaranteed method to prevent appendicitis, but some studies suggest:
- High-fiber diet may lower risk
- Early treatment of GI infections
- Regular medical check-ups
Prognosis
- Excellent if treated promptly
- Full recovery in 1–3 weeks post-surgery
- Delayed presentation or perforation may increase recovery time
- Recurrence is rare after appendectomy
- Mortality rate <1% in uncomplicated cases
Frequently Asked Questions (FAQs)
Q1: Can appendicitis go away without treatment?
A: Rarely. While early inflammation might subside, most cases worsen and need surgery.
Q2: How fast does appendicitis progress?
A: Symptoms typically escalate over 24–48 hours. Delay in treatment increases the risk of rupture.
Q3: What does appendix pain feel like?
A: Starts as vague pain around the navel, becomes sharp and localized in the lower right abdomen.
Q4: Can children get appendicitis?
A: Yes, it’s common in children, though diagnosis may be more difficult due to non-specific symptoms.
Q5: Is laparoscopic surgery safe for appendicitis?
A: Yes, it's the preferred approach due to minimal invasiveness and quicker recovery.
Final Thoughts
Acute appendicitis is a surgical emergency that requires prompt attention. With modern imaging and surgical techniques, outcomes are excellent. Knowing the early signs and seeking medical help can prevent complications and ensure a smooth recovery.
