From the Research
Introduction to Acute Appendicitis
Acute appendicitis is a common abdominal emergency that requires prompt diagnosis and treatment. The clinical presentation of acute appendicitis can be variable, making diagnosis challenging.
Signs of Acute Appendicitis
The signs of acute appendicitis include:
- Abdominal pain, which is the primary presenting complaint, often starting as vague periumbilical pain and migrating to the right lower quadrant 1, 2
- Nausea, vomiting, and anorexia, which occur in varying degrees 2, 3
- Localized tenderness and muscular rigidity in the right iliac fossa 2
- Rebound tenderness in the right lower quadrant, which can be present even in the absence of fever and biological inflammatory signs 1
Diagnostic Considerations
The diagnosis of acute appendicitis is based on a combination of history, physical examination, laboratory evaluation, and imaging 4, 3. Laboratory data may reveal an elevated leukocytosis with a left shift, and measurement of C-reactive protein is often elevated 2. Imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can be used to confirm the diagnosis 2, 5.
Treatment Options
Treatment of acute appendicitis depends on the presentation and whether the disease is uncomplicated or complicated 3, 5. Uncomplicated appendicitis can be managed with antibiotics, such as piperacillin-tazobactam monotherapy or combination therapy with cephalosporins or fluoroquinolones with metronidazole 3. However, patients with high-risk CT findings, such as appendicolith, mass effect, or a dilated appendix, are more likely to require surgical management 3. Complicated acute appendicitis should undergo timely surgical intervention 5.
Special Considerations
Certain patient populations, such as pregnant patients and immunosuppressed patients, should be considered for surgical intervention to decrease the risk of complications 5. Patients presenting with a large appendiceal abscess or phlegmon should undergo percutaneous drainage and antibiotic management 5.
Conclusion
Acute appendicitis is a common abdominal emergency that requires prompt diagnosis and treatment. A combination of history, physical examination, laboratory evaluation, and imaging is used to confirm the diagnosis. Treatment options depend on the presentation and whether the disease is uncomplicated or complicated, with antibiotics and surgery being the mainstay of treatment 1, 4, 2, 3, 5.