Elsevier

Current Surgery

Volume 60, Issue 5, September–October 2003, Pages 502-505
Current Surgery

Current reviews in gastrointestinal, minimally invasive, & endocrine surgery
Acute appendicitis: current diagnosis and treatment

https://doi.org/10.1016/S0149-7944(03)00131-4Get rights and content

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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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  • Cited by (39)

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      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 Print
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