Acute appendicitis is one of the more important disorders encountered in clinical practice, with more than 250,000 appendectomies performed in the United States on an annual basis [1] [2] [3]. The primary reason is the life-threatening risk of complications that may arise, the most important one being a perforated appendix [1] [4]. The clinical presentation of an acute appendicitis is characterized by a sudden onset of mild and cramping abdominal pain in the periumbilical area followed by its progression into a motion-aggravated and severe pain in the right lower quadrant after about 24 hours [2] [3]. Additional signs include fever (37.2-38.0°C) and anorexia (which is considered to be a diagnostic hallmark), whereas vomiting, altered bowel movements, and voiding difficulties are other notable findings [2] [3]. Studies have shown that the appendix can often perforate before patients arrive at the hospital and that younger age, as well as longer duration of abdominal pain, are indicative of this event [1] [5]. Moreover, a very high temperature (> 38.3°C), tachycardia, and profound tenderness of the abdomen have also been documented as possible signs of perforation [2]. Although the differential diagnosis of periumbilical and right lower quadrant pain is broad, acute appendicitis must be suspected early on as delay in diagnosis is the principal reason for mortality rates of a perforated appendix to increase up to 10 times [6].

• Pain

  A sudden onset of abdominal pain, fever and vomiting must include acute appendicitis as a possible cause. [symptoma.com]

  The patient returned a few days later with ongoing abdominal pain. A CT scan revealed a perforated appendix with acute appendicitis, as well as a small abscess with fluid. [theexpertinstitute.com]

  8.0 Pain migration 3.2 Pain before vomiting 2.8 Anorexia, nausea and vomiting* Much lower LR+ than RLQ pain, pain migration and pain before vomiting Psoas sign 2.38 Rebound tenderness 1.1 to 6.3† Fever 1.9‡ Guarding and rectal tenderness* Much lower [aafp.org]

  Sharp pain in the abdomen One of the most notable symptoms of a burst appendix is severe, sharp pain in the lower right quadrant of the abdomen. In cases of acute appendicitis, the pain usually starts around the navel region. [phaa.com]

• Fever

  Previous attacks of appendicitis predispose to an acute flare-up at any time during the course of typhoid fever. The symptoms may be so FULL TEXT [annals.org]

  A sudden onset of abdominal pain, fever and vomiting must include acute appendicitis as a possible cause. [symptoma.com]

  Rising Fever And Chills Fever is one of the later symptoms of appendicitis. It is typically low grade in acute appendicitis. However, the fever may start rising once the appendix bursts. [healthhype.com]

  We present the emergency case of an 81-year-old patient with right inguinal pseudo-tumor, accompanied by marked local pain, nausea, low grade fever and bowel disorders. [ncbi.nlm.nih.gov]

• Inflammation

  Recovery from an appendectomy depends on the severity of the inflammation. If inflammation is mild, recovery can take a few days to a week. [medicinenet.com]

  The benign obstruction was caused by a periappendicular abscess with inflammation and oedema of the ureteral and periureteral tissues. The condition was normalized within 7 days. [ncbi.nlm.nih.gov]

  Cf Left-sided appendicitis. ap·pen·di·ci·tis ( ă-pen'di-sī'tis ) Inflammation of the vermiform appendix. [ appendix + G. -itis, inflammation] appendicitis Acute inflammation of the blind-ended ‘vermiform’ APPENDIX. [medical-dictionary.thefreedictionary.com]

• Sepsis

  The incidences of major wound sepsis, paralytic ileus, intraperitoneal abscess and urinary infection were observed in 55%, 42.5%, 12.5% and 15% respectively in drainage group and 50%, 28.3%, 21.7% and 15.2% respectively in non-drainage group. [ncbi.nlm.nih.gov]

  But the bacteria can also enter the bloodstream and lead to sepsis which is life threatening. [healthhype.com]

  This may progress to potentially fatal sepsis when the bacteria gain access to the bloodstream and spread throughout the body. [phaa.com]

• High Fever

  Vomiting, high fever......(I suspect it had ruptured at this point.) Took him to ER. Fever was 104.4 degrees. Had appendectomy. [allnurses.com]

  The fevers can be as high as 102 F (38.9C) or sometimes even higher. The initial low-grade fever may resolve at times as does the pain, and a high fever suddenly sets in within 24 to 48 hours. [healthhype.com]

  If the appendix perforates, the patient may briefly feel better, followed by rapid deterioration, intense abdominal pain, spasms of the abdominal wall muscles (rigidity), elevated heart rate, and high fever. [innerbody.com]

• Abdominal Pain

  A sudden onset of abdominal pain, fever and vomiting must include acute appendicitis as a possible cause. [symptoma.com]

  The patient returned a few days later with ongoing abdominal pain. A CT scan revealed a perforated appendix with acute appendicitis, as well as a small abscess with fluid. [theexpertinstitute.com]

  Abdominal Pain or Swelling Abdominal pain is the most common symptom associated with appendicitis or burst appendix. Sensations of pain can arise suddenly and typically begin near the belly button. [livestrong.com]

  The main symptom of appendicitis is abdominal pain. [emedicinehealth.com]

• Vomiting

  A sudden onset of abdominal pain, fever and vomiting must include acute appendicitis as a possible cause. [symptoma.com]

  After an appendectomy, call your doctor right away if you have: Persistent vomiting Continued pain in your abdomen Dizziness /feelings of faintness Blood in your vomit, urine, or stool Fever Diarrhea [m.webmd.com]

  Recurrent nausea and vomiting Nausea and vomiting are also common in appendicitis. The symptoms of nausea begin early in cases of acute appendicitis, and usually accompany the pain in the navel region. Vomiting may also occur. [phaa.com]

  Nausea And Vomiting Returns Again Nausea is one of the common symptoms of acute appendicitis. It starts early, usually around the same time as the ache around the navel. There may also be vomiting. The nausea and vomiting may pass after a few hours. [healthhype.com]

• Nausea

  We present the emergency case of an 81-year-old patient with right inguinal pseudo-tumor, accompanied by marked local pain, nausea, low grade fever and bowel disorders. [ncbi.nlm.nih.gov]

  Recurrent nausea and vomiting Nausea and vomiting are also common in appendicitis. The symptoms of nausea begin early in cases of acute appendicitis, and usually accompany the pain in the navel region. Vomiting may also occur. [phaa.com]

  Nausea And Vomiting Returns Again Nausea is one of the common symptoms of acute appendicitis. It starts early, usually around the same time as the ache around the navel. There may also be vomiting. The nausea and vomiting may pass after a few hours. [healthhype.com]

  Fewer than 50% of people with appendicitis have the traditionally described symptoms in which pain begins in the upper abdomen or around the navel, then nausea and vomiting develop, and then, after a few hours, the nausea passes, and the pain shifts to [merckmanuals.com]

• Constipation

  You may also become constipated or develop severe diarrhea. If you’re having trouble passing gas, this may be a sign of a partial or total obstruction of your bowel. This may be related to underlying appendicitis. [healthline.com]

  Some pain medications can make a child constipated, so ask your health care provider or pharmacist about any side effects the medication might have. Moving around after surgery rather than lying in bed can help prevent constipation. [stanfordchildrens.org]

  There are no definitive risk factors for the development of appendicitis, although some studies suggest constipation and family history of appendicitis may put people at an increased risk. [surgery4children.com]

  Loss of appetite Nausea or vomiting soon after abdominal pain begins Abdominal swelling Temperature of 100 to 101 degrees Fahrenheit Constipation or diarrhea with gas Inability to pass gas In many cases, atypical symptoms appear, including: Dull or sharp [m.webmd.com]

  Other symptoms may include Swelling in the abdomen Loss of appetite Nausea and vomiting Constipation or diarrhea Inability to pass gas Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical emergency. [icdlist.com]

• Acute Abdomen

  Here we report a rare complication of a common ‘acute abdomen’ condition and the probable aetiologies and treatment modalities for the same. [npplweb.com]

  Some surgeons opt for a conservative treatment by means of an intravenous antibiotic therapy to solve acute abdomen [1–4] pain, planning a routinary interval appendectomy (IA) after some months. [ncbi.nlm.nih.gov]

  Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 45. Updated by: Raymond S. [medlineplus.gov]

  In the present case, the cause of the acute abdomen was most likely a combination of tumor infiltration, as indicated by the histological and immunohistochemical findings, and paclitaxel therapy. [ispub.com]

  Discussion Appendicitis is one of the most common causes of acute abdomen in the world. The diagnosis is usually straightforward, often being made by clinical evaluation alone. [tropicalgastro.com]

• Tachycardia

  Moreover, a very high temperature (> 38.3°C), tachycardia, and profound tenderness of the abdomen have also been documented as possible signs of perforation. [symptoma.com]

  On evaluation patient had tachycardia and fever. Clinical examination revealed a 1 x 2 cm swelling at umbilicus which was tender on palpation. The swelling was indurated and firm and was non-reducible. The cough impulse was absent. [avensonline.org]

  Other indications of peritonitis include increasing abdominal distension, acute abdomen, tachycardia, rapid and shallow breathing, and restlessness. [medical-dictionary.thefreedictionary.com]

• Sweating

  In cases of chronic presentation the usual signs are Ascites which is gradual and progressive – 96% Fever low grade with night sweats - 75 % [ 4 ]. [omicsonline.org]

  Fever symptoms are typically low-grade and may occur in conjunction with headache, sweating or chills. [livestrong.com]

• Headache

  Fever symptoms are typically low-grade and may occur in conjunction with headache, sweating or chills. [livestrong.com]

  Metronidazole is associated with dose-related GI disturbances, including nausea, unpleasant taste in the mouth, vomiting, and diarrhea. 22 Weakness, dizziness, ataxia, headache, drowsiness, insomnia, and changes in mood or mental state may occur. [uspharmacist.com]

• Pelvic Pain

  Appendicitis that occurs in these people can cause lower back pain or pelvic pain. Mild fever Appendicitis usually causes a fever between 99°F (37.2°C) and 100.5°F (38°C). You may also have the chills. [healthline.com]

  Because many gynecologic conditions can mimic appendicitis, a pelvic examination should be performed on all women with abdominal pain. [aafp.org]

A detailed patient history and a thorough physical examination are the cornerstone in the diagnosis of an acute appendicitis and perforation [2] [3]. Physicians must determine the exact timeline regarding symptom onset, especially abdominal pain, and its location can confirm the diagnosis. Abdominal tenderness at the McBurney point (located in the first third of a line joining the anterior superior iliac spine and the umbilicus) is the most important finding that will suggest appendicitis, while guarding, severe tenderness, and even a localized mass are signs of perforation [2] [3]. In some patients, abdominal pain can be induced with passive internal rotation of the thigh in flexion and by right hip extension (the obturator and psoas signs, respectively). As soon as an infectious etiology is suspected to be the cause of abdominal pain, laboratory studies comprisingof a complete blood count (CBC) and evaluation of inflammatory parameters is mandatory, as leukocytosis of more than 20,000 cells/mm3 and increased levels of C-reactive protein (CRP) are not only present in acute appendicitis but are also probable signs of perforation [1] [2]. Additionally, hyperbilirubinemia and the neutrophil-to-lymphocyte ratio (NLR) were identified as key features that suggest a perforated appendix [4] [7]. The role of imaging studies is questionable when it comes to visualizing a perforated appendix. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) have all been identified as efficient methods to diagnose acute appendicitis, with helical CT and MRI showing the highest specificity and sensitivity rates [2] [3] [6]. Their respective roles in confirming perforation of the appendix, however, have not been confirmed [6], which is why the diagnosis rests on clinical and laboratory findings.

Initial antibiotic treatment followed by interval appendectomy would become a more likely treatment option if our study results can be validated in a prospective study. [ncbi.nlm.nih.gov]

How did the usual treatment of doing an appendectomy (appendix removal) arise? In 1886 Dr. [lactobacto.com]

Women's abdomens had been entered occasionally for treatment of ovarian cysts — men's abdomens rarely, on any pretext. For a pathologist-physician like Reginald H. [nejm.org]

The prognosis is good in cases of integrity of the appendix. [scielo.br]

Post View 31 Comments Appendicitis - Prognosis Did you experience any complications with your appendicitis? Post View 5 Comments CONTINUE SCROLLING FOR RELATED ARTICLE [emedicinehealth.com]

Perforation was never investigated or mentioned as a possible negative factor on recurrence or prognosis. [link.springer.com]

[…] quadrant pain, usu. younger patients Signs rebound tenderness, tenderness at McBurney's point, Rovsing sign, psoas sign, obturator sign Prevalence common Blood work leukocytosis Radiology periappendiceal fat stranding, increased appendiceal diameter Prognosis [librepathology.org]

Surgeons should remember that an underlying oncologic process may be the etiology of appendicitis in a small but important subgroup of patients. [ncbi.nlm.nih.gov]

As soon as an infectious etiology is suspected to be the cause of abdominal pain, laboratory studies comprisingof a complete blood count (CBC) and evaluation of inflammatory parameters is mandatory, as leukocytosis of more than 20,000 cells/mm3 and increased [symptoma.com]

+/- Vascular thrombosis (and necrosis ) - known as gangrenous appendicitis. [6] +/- Findings suggestive of etiology - usu. absent: +/- Fecalith. +/- Viral inclusions (extremely rare) See adenovirus appendicitis. [librepathology.org]

Etiology Appendicitis is caused by obstruction of the appendiceal lumen. [emedicine.medscape.com]

Appendicitis: The Etiology, Hygienic, and Dietetic Treatment. Pahrump, NV: Library of New Atlantis, 2003. Harvard Medical School. Medical Tests: A Practical Guide to Common Tests. Boston, MA: Harvard Health Publications, 2004. [healthofchildren.com]

Epidemiologic Reviews Call for Papers We invite you to learn more about submitting your research to Volume 42 of Epidemiologic Reviews to be published in 2020. The theme is “The Epidemiology of Prescription and Illegal Drug Dependence." [aje.oxfordjournals.org]

Also Read: Appendicitis: Classification and Types, Epidemiology, Pathophysiology, Causes, Risk Factors, Symptoms, Signs, Treatment, Tests Acute Appendicitis: Causes, Signs, Symptoms, Treatment [epainassist.com]

One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063–72. doi: 10.1200/JCO.2007.15.4377. PubMed CrossRef Google Scholar 8. [link.springer.com]

An American Journal of Epidemiology study in 1990 found that appendicitis was a common condition affecting approximately 6.7% of females and 8.6% of males. In the U.S. 250,000 cases of appendicitis are reported annually. [emedicinehealth.com]

Pathophysiology The simple pathophysiology of appendicitis follows the typical pathophysiology of infection. Obstruction. The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith, tumor, or foreign body. [nurseslabs.com]

Also Read: Appendicitis: Classification and Types, Epidemiology, Pathophysiology, Causes, Risk Factors, Symptoms, Signs, Treatment, Tests Acute Appendicitis: Causes, Signs, Symptoms, Treatment [epainassist.com]

Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis, 9e. Philadelphia, PA: Elsevier; 2010. Appendicitis. [innerbody.com]

[…] and young adults, most commonly occurring between early teens and 25 but may occur at any age; higher incidence in younger subjects likely related to increased lymphoid tissue More common with a low bulk Western diet, less common in Africa and Asia Pathophysiology [pathologyoutlines.com]

Appendicitis may occur for several reasons, such as an infection of the appendix, but the most important factor is the obstruction of the appendiceal lumen (see Pathophysiology and Etiology ). [emedicine.medscape.com]

This reason for an appendectomy (that it would prevent serious infection) became established in medical thought and still guides appendicitis management today. But nowadays we have antibiotics! [lactobacto.com]

Early diagnosis and prompt surgical treatment have long been advocated for acute appendicitis to prevent the consequences of perforation. [indiana.pure.elsevier.com]

There is no way to prevent appendicitis. However, appendicitis may be less common in people who eat foods high in fiber, such as fresh fruits and vegetables. [webmd.com]

1. Drake FT, Mottey NE, Farrokhi ET, et al. Time to Appendectomy and Risk of Perforation in Acute Appendicitis. JAMA surg. 2014;149(8):837-844.
2. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
3. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012
4. Chaudhary P, Kumar A, Saxena N, Biswal UC. Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study. Ann Gastroenterol. 2013;26(4):325-331.
5. Hung MH, Lin LH, Chen DF. Clinical manifestations in children with ruptured appendicitis. Pediatr Emerg Care. 2012;28(5):433-435.
6. Leeuwenburgh MM, Wiezer MJ, Wiarda BM, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. Br J Surg. 2014;101(1):e147-155.
7. Sevinç MM, Kınacı E, Çakar E, et al. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg. 2016;22(2):155-162.