Current reviews in gastrointestinal, minimally invasive, & endocrine surgeryAcute appendicitis: current diagnosis and treatment
Section snippets
Etiology
Acute appendicitis is the clinical diagnosis of an inflammatory reaction in the appendix, which up to 85% of the time is secondary to occlusion of the appendiceal lumen; the remaining 15% of appendicitis cases have no known etiology. Any process that limits or prevents the drainage of appendiceal secretions may cause congestion of the appendix and subsequent appendicitis.
Two common mechanisms for occlusion of the appendiceal orifice are proliferation of lymphoid tissue and the presence of a
Presentation and diagnosis
Clinical diagnosis of appendicitis relies on a detailed history and thorough physical examination. The complexity of the diagnosis lies in the variability of presenting symptoms. Difficulties may arise in eliciting a complete history and thorough physical examination from young children. Elderly patients may present with vague abdominal pain or even no pain at all. With the age-related increased risk of other pathologic entities, such as diverticulitis and cancer, the diagnosis of appendicitis
Treatment
Both surgical and nonsurgical treatments exist for acute appendicitis. Nonsurgical therapy includes the combination of prolonged antibiotic therapy and close clinical monitoring. Importantly, it has been noted that approximately 40% of initially nonsurgically treated appendicitis cases eventually required operative intervention.14 Therefore, the mainstay of therapy remains surgery. In isolated cases of appendiceal perforation with a well-localized abscess, initial nonsurgical management
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Appendix
Cited by (39)
Recognizing acute appendicitis criteria on abdominal CT: Do Emergency physicians need a preliminary report?
2015, American Journal of Emergency MedicineCitation Excerpt :To reduce the number of negative appendectomies, a clinical scoring system, ultrasonography, and computed tomography (CT) have been evaluated [4–6]. For the diagnosis of AA, recent reports have supported the widespread use of CT in the evaluation of patients with suspected AA, citing sensitivity, specificity, and accuracy rates of 98%, 97%, and 98%, respectively [7–12]. Although recent literature has established the capability of radiology residents or fellows to interpret radiologic images in the ED, only a few studies have been published regarding the capability of emergency physicians to do so as well [13–16].
Diseases of the Appendix
2014, Textbook of Gastrointestinal Radiology: Volumes 1-2, Fourth EditionIncidental appendectomy in donors undergoing hepatectomy for living-donor liver transplantation
2012, Transplantation ProceedingsDiagnosis of acute appendicitis
2012, International Journal of SurgeryCitation Excerpt :Nausea, vomiting, and anorexia occur in varying degrees, though are usually present in more than 50% of cases in all studies. With disease progressing as previously outlined, pain becomes well defined and localises in the right lower quadrant near McBurney’s point.2 Accordingly, the clinician should not consider it the sine qua non for the diagnosis of acute appendicitis.
High-Yield Imaging: Gastrointestinal: A volume in High Yield in Radiology
2010, High Yield Imaging: Gastrointestinal Expert Consult - Online and PrintDesign and instrumentation of new devices for performing appendectomy at colonoscopy (with video)
2008, Gastrointestinal Endoscopy