From the Guidelines
Appendicitis typically presents with pain that begins around the navel and then shifts to the lower right abdomen, becoming more intense over several hours, and is often accompanied by other symptoms such as loss of appetite, nausea, vomiting, and fever, as noted in the most recent study by 1. The clinical presentation of appendicitis can vary, but common signs and symptoms include:
- Pain that begins around the navel and then shifts to the lower right abdomen
- Loss of appetite
- Nausea
- Vomiting
- Low-grade fever
- Constipation or diarrhea
- Abdominal bloating
- Inability to pass gas
- Rebound tenderness in the right lower quadrant, specifically at McBurney's point These symptoms occur because the appendix becomes inflamed and infected, often due to a blockage that allows bacteria to multiply, as explained in 1. The inflammation irritates the surrounding tissues and peritoneum (abdominal lining), causing the characteristic pain patterns. If you experience these symptoms, especially persistent abdominal pain that migrates to the lower right abdomen, seek immediate medical attention as untreated appendicitis can lead to rupture, causing peritonitis, a serious infection that can be life-threatening, as highlighted in 1 and 1. It's essential to note that the presentation of appendicitis can be atypical, especially in certain populations such as the elderly, as discussed in 1, and that diagnostic scoring systems and imaging modalities can aid in diagnosis, as mentioned in 1 and 1. However, the most recent and highest-quality study, 1, provides the most relevant guidance on the signs and symptoms of appendicitis.
From the Research
Signs and Symptoms of Appendicitis
The signs and symptoms of appendicitis can vary, but common symptoms include:
- Vague periumbilical pain that migrates to the right lower quadrant 2, 3
- Anorexia, nausea, and intermittent vomiting 2, 3
- Low-grade fever 2, 3
- Abdominal rigidity and periumbilical pain radiating to the right lower quadrant 2
- Absent or decreased bowel sounds, a positive psoas sign, a positive obturator sign, and a positive Rovsing sign are most reliable for ruling in acute appendicitis in children 2
- Tenderness and guarding in the right iliac fossa 4
Atypical Presentations
Atypical presentations of appendicitis are common, especially in preschool children and during pregnancy:
- Abdominal pain, nausea, and vomiting are important symptoms during pregnancy, but peritoneal signs may occur in the upper quadrant or entire right side due to the enlarging uterus 5
- Atypical presentations in children may include diffuse abdominal pain or pain in the right upper quadrant 4
- Acute appendicitis can masquerade as acute scrotum, presenting with severe pain at the right hemiscrotum followed by mild diffuse abdominal pain 6
Diagnostic Challenges
Diagnosing appendicitis can be challenging, especially in cases with atypical presentations:
- Prompt diagnosis is crucial to prevent delayed treatment and perforation, which can lead to sepsis and increased morbidity and mortality 2, 5
- Clinical diagnosis is possible in most cases, but inflammatory markers and imaging studies such as ultrasound or CT scans may be necessary to confirm the diagnosis 2, 3, 4