Basics
- The appendix is a small, thin tube of bowel sprouting from the caecum
- Appendicitis is inflammation of the appendix
- Results from obstruction of the appendix and subsequent infection and inflammation of the appendix
- Peak incidence in ages 10-20
Symptoms
- Abdominal pain, typically central then settling in the right iliac fossa (RIF)
- Loss of appetite (anorexia), nausea and vomiting.
Signs
- Tender to McBurney’s point (1/3 the distance from the ASIS to umbilicus)
- Guarding to RIF
- Rebound tenderness (increased pain when releasing deep palpation to the RIF) and percussion tenderness indicate peritonitis
- Rovsing’s sign (palpation of the left iliac fossa (LIF) causes pain in the RIF)
Diagnosis
- Diagnosis is mostly clinical based on signs and raised inflammatory markers
- CT can be useful in confirming diagnosis in confirming the diagnosis, particularly where other diagnosis more likely
- USS can be useful in women to exclude ovarian and gynae pathology
- If clinically appendicitis but tests are negative may proceed to diagnostic laparoscopy – appendicectomy
Common Differential Diagnoses
- Ectopic pregnancy (in women of childbearing age)
- Gynecological emergency with relatively high mortality if mismanaged
- Essential to get a serum bHCG to exclude pregnancy / ectopic
- Ovarian cysts (with torsion or rupture)
- Meckel’s diverticulitis
- Malformation of the distal ileum in 2% of the population
- Can become inflamed and infected in the same way as the appendix
- Mesenteric Adenitis (usually in younger patients)
- Abdominal pain caused by inflamed abdominal lymph nodes
- Often associated with cough/cold
- No treatment required
Appendix Mass
- Signs of appendicitis with palpable mass in RIF
- When the omentum and / or bowel surround and stick to the inflamed appendix
- Typically managed conservatively with supportive treatment and antibiotics, with appendicectomy once acute condition has resolved
Appendicectomy
- Definitive management for acute appendicitis
- Laparoscopic is associated with fewer risks and faster recovery versus open
- Complications:
- Bleeding / infection / pain / scars
- Damage to bowel, bladder or other organs
- Removal of normal appendix
- Anaesthetic risk
- DVT / PE