Global InformationAppendicitis information
| Appendicitis | |
|---|---|
| Other names | Epityphlitis[1] |
 | |
| An acutely inflamed and enlarged appendix, sliced lengthwise. | |
| Specialty | General surgery |
| Symptoms | Periumbilical or right lower abdominal pain, vomiting, decreased appetite[2] |
| Complications | Abdominal inflammation, sepsis[3] |
| Diagnostic method | Based on symptoms, medical imaging, blood tests[4] |
| Differential diagnosis | Mesenteric adenitis, cholecystitis, psoas abscess, abdominal aortic aneurysm[5] |
| Treatment | Surgical removal of the appendix, antibiotics[6][7] |
| Frequency | 11.6 million (2015)[8] |
| Deaths | 50,100 (2015)[9] |
Appendicitis is inflammation of the appendix.[2] Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite.[2] However, approximately 40% of people do not have these typical symptoms.[2] Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis.[3]
Appendicitis is primarily caused by a blockage of the hollow portion in the appendix.[10] This blockage typically results from a fecaloma, a calcified "stone" made of feces.[6] Other factors such as inflamed lymphoid tissue from a viral infection, intestinal parasites, gallstone, or tumors may also lead to this blockage.[6] When the appendix becomes blocked, it experiences increased pressure, reduced blood flow, and bacterial growth, resulting in inflammation.[6][11] This combination of factors causes tissue injury and, ultimately, tissue death.[12] If this process is left untreated, it can lead to the appendix rupturing, which releases bacteria into the abdominal cavity, potentially leading to severe complications.[12][13]
The diagnosis of appendicitis is largely based on the person's signs and symptoms.[11] In cases where the diagnosis is unclear, close observation, medical imaging, and laboratory tests can be helpful.[4] The two most commonly used imaging tests for diagnosing appendicitis are ultrasound and computed tomography (CT scan).[4] CT scan is more accurate than ultrasound in detecting acute appendicitis.[14] However, ultrasound may be preferred as the first imaging test in children and pregnant women because of the risks associated with radiation exposure from CT scans.[4] Although ultrasound may aid in diagnosis, its main role in identifying important differentials, such as ovarian pathology in females or mesenteric adenitis in children.
The standard treatment for acute appendicitis involves the surgical removal of the inflamed appendix.[6][11] This procedure can be performed either through an open incision in the abdomen (laparotomy) or using minimally invasive techniques with small incisions and cameras (laparoscopy). Surgery is essential to reduce the risk of complications or potential death associated with the rupture of the appendix.[3] Antibiotics may be equally effective in certain cases of non-ruptured appendicitis.[15][7][16] It is one of the most common and significant causes of sudden abdominal pain. In 2015, approximately 11.6 million cases of appendicitis were reported, resulting in around 50,100 deaths worldwide.[8][9] In the United States, appendicitis is one of the most common causes of sudden abdominal pain requiring surgery.[2] Annually, more than 300,000 individuals in the United States undergo surgical removal of their appendix.[17] Reginald Fitz is credited with being the first person to describe the condition in 1886.[18]
- ^ "appendicitis". Medical Dictionary. Merriam-Webster. Archived from the original on 2013-12-30.
- ^ a b c d e Graffeo CS, Counselman FL (November 1996). "Appendicitis". Emergency Medicine Clinics of North America. 14 (4): 653–671. doi:10.1016/s0733-8627(05)70273-x. PMID 8921763.
- ^ a b c Hobler K (Spring 1998). "Acute and Suppurative Appendicitis: Disease Duration and its Implications for Quality Improvement" (PDF). Permanente Medical Journal. 2 (2). Archived from the original (PDF) on 2021-03-06. Retrieved 2016-10-26.
- ^ a b c d Paulson EK, Kalady MF, Pappas TN (January 2003). "Clinical practice. Suspected appendicitis" (PDF). The New England Journal of Medicine. 348 (3): 236–242. doi:10.1056/nejmcp013351. PMID 12529465. Archived from the original (PDF) on 2017-09-22. Retrieved 2017-11-01.
- ^ Ferri FF (2010). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd ed.). Philadelphia, PA: Elsevier/Mosby. pp. Chapter A. ISBN 978-0-323-07699-9.
- ^ a b c d e Longo DL, et al., eds. (2012). Harrison's principles of internal medicine (18th ed.). New York: McGraw-Hill. pp. Chapter 300. ISBN 978-0-07-174889-6. Archived from the original on 30 March 2016. Retrieved 6 November 2014.
- ^ a b Varadhan KK, Neal KR, Lobo DN (April 2012). "Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials". BMJ. 344: e2156. doi:10.1136/bmj.e2156. PMC 3320713. PMID 22491789.
- ^ a b GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
- ^ a b GBD 2015 Mortality and Causes of Death Collaborators (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
- ^ Pieper R, Kager L, Tidefeldt U (1982). "Obstruction of appendix vermiformis causing acute appendicitis. An experimental study in the rabbit". Acta Chirurgica Scandinavica. 148 (1): 63–72. PMID 7136413.
- ^ a b c Tintinalli JE, ed. (2011). Emergency medicine: a comprehensive study guide (7th ed.). New York: McGraw-Hill. pp. Chapter 84. ISBN 978-0-07-174467-6. Archived from the original on 22 December 2016. Retrieved 6 November 2014.
- ^ a b Schwartz's principles of surgery (9th ed.). New York: McGraw-Hill, Medical Pub. Division. 2010. pp. Chapter 30. ISBN 978-0-07-154770-3.
- ^ Barrett ML, Hines AL, Andrews RM (July 2013). "Trends in Rates of Perforated Appendix, 2001–2010" (PDF). Healthcare Cost and Utilization Project (HCUP) Statistical Brief #159. Rockville, MD: Agency for Healthcare Research and Quality. PMID 24199256. Archived (PDF) from the original on 2016-10-20.
- ^ Shogilev DJ, Duus N, Odom SR, Shapiro NI (November 2014). "Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014". The Western Journal of Emergency Medicine (Review). 15 (7): 859–871. doi:10.5811/westjem.2014.9.21568. PMC 4251237. PMID 25493136.
- ^ Javanmard-Emamghissi H (2021). "Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study". The British Journal of Surgery. 108 (11): 1351–1359. doi:10.1093/bjs/znab287. PMC 8499866. PMID 34476484. Retrieved 8 September 2021.
- ^ "Appendicitis: Surgical vs. Medical Treatment | Science-Based Medicine". sciencebasedmedicine.org. 2020-11-24. Retrieved 2022-11-04.
- ^ Mason RJ (August 2008). "Surgery for appendicitis: is it necessary?". Surgical Infections. 9 (4): 481–488. doi:10.1089/sur.2007.079. PMID 18687030.
- ^ Fitz RH (1886). "Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment". American Journal of the Medical Sciences (92): 321–346.