Appendicitis 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. Causes 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 eventually death. 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 Diagnosis is based on history and physical examination backed by blood tests and other diagnostic procedures. 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 sign. 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. Treatment 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 inflammation. Prognosis 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 impossible