Can appendicitis present with sudden onset of abdominal pain?

From the Guidelines

Yes, appendicitis can present with sudden onset of abdominal pain, which often begins around the umbilicus and then migrates to the right lower quadrant of the abdomen. The pain pattern occurs because appendicitis starts with obstruction of the appendix lumen, causing distension and inflammation, as noted in the study by 1. Initially, the pain is perceived in the central abdomen because the appendix inflammation irritates visceral nerve fibers, which are poorly localized. As inflammation progresses and involves the peritoneum, the pain becomes more localized to the right lower quadrant. Associated symptoms often include nausea, vomiting, loss of appetite, and low-grade fever, as discussed in the study by 1. Movement, coughing, or deep breathing may worsen the pain. Anyone experiencing sudden abdominal pain, especially if it migrates to the right lower quadrant and is accompanied by these symptoms, should seek immediate medical attention as appendicitis is a surgical emergency requiring prompt evaluation and often appendectomy to prevent rupture and peritonitis, as emphasized in the study by 1. Some key points to consider in the diagnosis and management of appendicitis include:

• The clinical presentation of appendicitis can be inconsistent, and diagnostic scoring systems may be helpful in establishing a diagnosis, as noted in the study by 1.
• Imaging studies, such as ultrasound or computed tomography, can aid in the diagnosis of appendicitis, as discussed in the study by 1.
• Appendectomy remains the treatment of choice for acute appendicitis, although antibiotic therapy may be considered for patients with uncomplicated appendicitis, as noted in the study by 1.
• Laparoscopic appendectomy is a safe and effective approach to surgical treatment, but open surgery may still be necessary in some cases, as discussed in the study by 1. Overall, prompt recognition and treatment of appendicitis are essential to prevent complications and improve outcomes, as emphasized in the study by 1.

From the Research

Appendicitis Onset

• Appendicitis can present with sudden onset of abdominal pain, which is a common symptom of the condition 2.
• The clinical diagnosis of acute appendicitis is based on history and physical, laboratory evaluation, and imaging, with classic symptoms including vague periumbilical pain, anorexia/nausea/intermittent vomiting, migration of pain to the right lower quadrant, and low-grade fever 2.
• Approximately 90% of patients presenting with these symptoms are diagnosed with acute appendicitis 2.

Treatment and Outcomes

• Appendectomy remains the standard treatment for acute appendicitis, but antibiotic therapy has been proposed as an alternative for uncomplicated cases 3, 4, 5, 6.
• Studies have shown that antibiotic therapy can be effective in treating uncomplicated appendicitis, with success rates ranging from 63% to 73% at one year 3, 4.
• However, recurrence rates can be high, with up to 30% of patients experiencing recurrence within one year 4, 6.
• The choice between appendectomy and antibiotic therapy should be based on individual patient factors, including the presence of risk factors for failure of non-operative management and patient preferences 4, 2.

Antibiotic Therapy

• Broad-spectrum antibiotics, such as piperacillin-tazobactam monotherapy or combination therapy with either cephalosporins or fluroquinolones with metronidazole, have been shown to be effective in treating uncomplicated acute appendicitis 2.
• The duration of antibiotic treatment is typically 8 to 15 days 3.
• Antibiotic therapy may be associated with a higher rate of unsuccessful treatment and recurrence, but may also reduce the risk of wound infections and other complications 6.