From the Guidelines
Diarrhea can be a symptom of acute appendicitis, but it is not a typical or primary symptom, occurring in approximately 10-20% of cases, particularly when the inflamed appendix irritates the nearby bowel. Most commonly, acute appendicitis presents with pain that begins around the umbilicus and migrates to the right lower quadrant, along with nausea, vomiting, fever, and loss of appetite. The presence of diarrhea doesn't rule out appendicitis, especially if accompanied by the classic pain pattern and other symptoms. The pathophysiology involves local inflammation affecting bowel motility or the appendix's position near the colon causing irritation.
Key Points to Consider
- The clinical presentation of appendicitis can be inconsistent, and atypical presentations may lead to delays in diagnosis and treatment 1.
- Diagnostic scoring systems, such as the Alvarado score, can aid in predicting the risk of acute appendicitis, but none have been widely accepted 1.
- Imaging modalities, including ultrasound, CT, and MRI, play a crucial role in the diagnosis of acute appendicitis, particularly in patients with a high degree of suspicion or equivocal clinical findings 1.
- Recent advances in technology have led to the development of new imaging techniques, such as sonographic elastography, diffusion-weighted imaging, and dual-energy CT, which may improve diagnostic performance and reduce dependence on CT 1.
Recommendations for Diagnosis and Treatment
- Patients with suspected acute appendicitis should undergo a thorough clinical evaluation, including laboratory tests and imaging studies, to confirm the diagnosis and rule out other causes of abdominal pain 1.
- The choice of imaging modality should be tailored to the individual patient, taking into account factors such as age, pregnancy status, and clinical presentation 1.
- Surgical removal of the appendix remains the gold standard treatment for acute appendicitis, although non-operative management with antibiotics may be considered in select cases of uncomplicated appendicitis 1.
Importance of Prompt Medical Attention
If someone experiences abdominal pain that worsens over time, particularly if it localizes to the right lower quadrant, they should seek medical attention promptly, regardless of whether diarrhea is present, as appendicitis requires timely diagnosis and treatment to prevent complications and improve outcomes 1.
From the Research
Symptoms of Acute Appendicitis
- Classic symptoms of appendicitis include vague periumbilical pain, anorexia/nausea/intermittent vomiting, migration of pain to the right lower quadrant, and low-grade fever 2
- Atypical presentations of acute appendicitis may occur, with symptoms such as diarrhea and lower abdominal pain 3
- 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 4
Diarrhea as a Symptom
- Diarrhea can be a symptom of acute appendicitis, especially in atypical presentations 3
- A study found that diarrhea and vomiting can be initial symptoms of acute appendicitis, mimicking acute gastroenteritis 5
- Independent predictors of acute appendicitis include vomiting, right lower quadrant pain, stool occult blood, white blood cell count, and C-reactive protein, but not specifically diarrhea 5
Diagnosis and Management
- The diagnosis of acute appendicitis is based on history, physical examination, laboratory evaluation, and imaging 2
- Laparoscopic appendectomy remains the most common treatment, but broad-spectrum antibiotics can successfully treat uncomplicated acute appendicitis in approximately 70% of patients 2
- 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 4