Appendicitis

Appendicitis is inflammation of the appendix. Appendicitis commonly presents with right lower abdominal pain, nausea, vomiting, and decreased appetite.^[2] However, approximately 40% of persons do not have these typical signs and 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 caused by a blockage of the hollow portion of the appendix,^[4][5] most commonly by a calcified "stone" made of feces. However, inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage.^[6] This blockage leads to increased pressures within the appendix, decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation.^[6][7] The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue death.^[8] If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to severe abdominal pain and increased complications.^[8][9]

The diagnosis of appendicitis is largely based on the person's signs and symptoms.^[7] In cases where the diagnosis cannot be made based on the person's history and physical exam, close observation, radiographic imaging and laboratory tests can often be helpful.^[10] The two most common imaging tests used are ultrasound and computed tomography (CT scan).^[10] CT scan has been shown to be more accurate than ultrasound in detecting acute appendicitis.^[11] 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.^[10]

The standard treatment for acute appendicitis is surgical removal of the appendix.^[6][7] This may be done by an open incision in the abdomen(laparotomy) or through a few smaller incisions with the help of cameras (laparoscopy). Surgery decreases the risk of side effects or death associated with rupture of the appendix.^[3] Antibiotics may be equally effective in certain cases of non-ruptured appendicitis.^[12] It is one of the most common and significant causes of severe abdominal pain that comes on quickly worldwide.