From the Guidelines
Appendicitis is most common in people between the ages of 10 and 30 years old, with peak incidence occurring in the teenage years and early twenties. However, appendicitis can affect people of any age, from infants to the elderly. The condition is slightly more common in males than females. In younger children (under 10) and older adults (over 50), appendicitis can be more difficult to diagnose because symptoms may present differently than the classic pattern.
Key Points
- The appendix is a small, finger-shaped pouch attached to the large intestine, and appendicitis occurs when this structure becomes inflamed, typically due to obstruction by fecal material, foreign bodies, or lymphoid tissue growth.
- The risk factors for developing appendicitis aren't clearly understood, but it appears to be related to dietary factors, with lower incidence in populations consuming high-fiber diets.
- While appendicitis can be life-threatening if left untreated, prompt medical attention and surgical removal of the appendix (appendectomy) typically results in excellent outcomes, as stated in the 2020 update of the WSES Jerusalem guidelines 1.
- According to the guidelines, the incidence of acute appendicitis (AA) has been declining steadily since the late 1940s, with a peak between the ages of 10 and 30 1.
- Geographical differences are reported, with a lifetime risk for AA of 9% in the USA, 8% in Europe, and 2% in Africa 1.
- The rate of perforation varies from 16% to 40%, with a higher frequency occurring in younger age groups (40–57%) and in patients older than 50 years (55–70%) 1.
- The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition) suggest that elderly patients with acute appendicitis have higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate, and higher risk of colonic and appendiceal cancer 1.
From the Research
Age Group Affected by Appendicitis
- Appendicitis is most common in the age group from 10 to 20 years, with a lifetime risk of 8.6% and 6.7% for males and females respectively 2
- The condition most commonly occurs between the ages of 11 and 20 years 3
- Acute appendicitis affects 96.5 to 100 people per 100 000 adults per year worldwide, indicating that it is not exclusive to the younger age group but can occur in adults as well 4
Clinical Characteristics and Diagnosis
- Classic symptoms of appendicitis include vague periumbilical pain, anorexia/nausea/intermittent vomiting, migration of pain to the right lower quadrant, and low-grade fever 4
- Right lower quadrant pain, abdominal rigidity, and periumbilical pain radiating to the right lower quadrant are the best signs for ruling in acute appendicitis in adults 5
- The Alvarado score, Pediatric Appendicitis Score, and Appendicitis Inflammatory Response score incorporate common clinical and laboratory findings to stratify patients as low, moderate, or high risk and can help in making a timely diagnosis 5, 2
Treatment and Management
- Appendectomy via open laparotomy or laparoscopy is the standard treatment for acute appendicitis, but intravenous antibiotics may be considered first-line therapy in selected patients 5, 6
- Antibiotic treatment can be offered as the first-line therapy to a majority of unselected patients with acute appendicitis without medical drawbacks other than the unknown risk for long-term relapse 6
- Surgical management should be recommended in patients with high-risk CT findings, such as appendicolith, mass effect, or a dilated appendix greater than 13 mm 4