Appendicitis is a condition
characterized by inflammation of the appendix. While mild cases may resolve
without treatment, many require laparotomy with removal of the inflamed
appendix. Untreated, mortality is high, mainly due to peritonitis and shock
when the inflamed appendix ruptures.
It is possible for matter to
become lodged in the appendix, leading to bacterial infection, which can
cause appendicitis. If the condition is untreated, the appendix can turn
gangrenous and can eventually burst, leading to peritonitis, septicemia and
Signs, symptoms and findings
The pain of appendicitis
usually starts centrally (peri-umbilical) before localizing to the right
iliac fossa (the lower right side of the abdomen). This is usually
associated anorexia (loss of appetite). Fever may also be present. Nausea
and diarrhea may or may not occur, but make the diagnosis more likely.
There is typically pain and
tenderness in the lower right side of the abdomen
Diagnosis is based on history
and physical examination backed by blood tests and other diagnostic
The classical physical
finding in appendicitis is diffuse pain in the umbilical region, which can
become localized at McBurney's point if the inflamed appendix comes into
contact with the parietal peritoneum. This point is located on the
right-hand side one-third of the distance between the anterior superior
iliac spine and the navel, or approximately one hand's width.
Other signs used in the
diagnosis of appendicitis are the psoas sign (common in retrocecal
appendicitis), the obturator (internus) sign, Blomberg's sign and Rovsing's
Ultrasonography and Doppler
sonography also provide useful means to detect appendicitis, but in a not
negligible minority of cases (15% approximately), especially those in an
early stadium without fluid build-up, an ultrasonography of the iliac fossa
region do not reveal abnormalities despite of present appendicitis. Yet,
sonographic imaging can often distinguish between appendicitis and another
disease with very similar symptoms, namely the inflammation of the lymph
nodes near the appendix.
Appendicitis can be treated
by removal of the appendix through a surgical procedure called an
appendicectomy (also known as an appendectomy).
Antibiotics are often given
intravenously to help kill remaining bacteria and thus reduce the
Most appendicitis patients
recover easily with treatment, but complications can occur if treatment is
delayed or if peritonitis occurs secondary to a perforated appendix.
Recovery time depends on age,
condition, complications and other circumstances but usually is between 10
and 28 days.
The real possibility of
life-threatening peritonitis is the reason why acute appendicitis warrants
speedy treatment. The patient may have to undergo a medical evacuation.
Appendicectomies have occasionally been performed in emergency conditions
(i.e. outside of a proper hospital), when a timely medical evacuation was