Appendicitis and Surgical Management
Acute appendicitis is one of the most common surgical emergencies encountered in clinical
practice. It is characterized by inflammation of the vermiform appendix and usually
requires prompt surgical intervention. Medical students must understand the clinical
presentation, diagnosis, complications, and treatment of appendicitis because delayed
management can lead to severe morbidity.
The appendix is a narrow tube attached to the caecum in the right iliac fossa. Acute
appendicitis commonly occurs due to obstruction of the appendiceal lumen by faecoliths,
lymphoid hyperplasia, parasites, or tumors. Obstruction causes increased intraluminal
pressure, bacterial overgrowth, ischemia, and inflammation.
Acute appendicitis may occur at any age but is more common in adolescents and young
adults. The classic symptom is abdominal pain that initially begins around the umbilicus
and later localizes to the right iliac fossa. This migration of pain occurs because early
visceral pain becomes localized when parietal peritoneal irritation develops.
Other symptoms include anorexia, nausea, vomiting, and low-grade fever. On examination,
patients may have tenderness at McBurney’s point, guarding, rebound tenderness, and
Rovsing’s sign. In advanced cases, generalized peritonitis may occur.
Diagnosis is mainly clinical but investigations are useful in supporting the diagnosis and
excluding other conditions. Laboratory findings may show leukocytosis with neutrophilia.
Urinalysis is often performed to exclude urinary tract pathology. Imaging studies such as
abdominal ultrasound and CT scan can improve diagnostic accuracy.
Differential diagnoses include gastroenteritis, ectopic pregnancy, pelvic inflammatory
disease, mesenteric adenitis, ovarian torsion, and renal colic. In female patients of
reproductive age, pregnancy testing is essential.
Management of acute appendicitis is primarily surgical. Appendicectomy may be performed
through open surgery or laparoscopic surgery. Laparoscopic appendicectomy is
increasingly preferred because it is associated with smaller scars, less postoperative pain,
and faster recovery.
Preoperative preparation includes intravenous fluids, analgesics, and antibiotics. Commonly
used antibiotics include ceftriaxone and metronidazole. Surgery should not be delayed
unnecessarily because perforation risk increases with time.
Complications of appendicitis include perforation, abscess formation, generalized
peritonitis, sepsis, and bowel obstruction. Perforated appendicitis may present with severe
abdominal pain, high fever, tachycardia, and signs of septic shock.
Acute appendicitis is one of the most common surgical emergencies encountered in clinical
practice. It is characterized by inflammation of the vermiform appendix and usually
requires prompt surgical intervention. Medical students must understand the clinical
presentation, diagnosis, complications, and treatment of appendicitis because delayed
management can lead to severe morbidity.
The appendix is a narrow tube attached to the caecum in the right iliac fossa. Acute
appendicitis commonly occurs due to obstruction of the appendiceal lumen by faecoliths,
lymphoid hyperplasia, parasites, or tumors. Obstruction causes increased intraluminal
pressure, bacterial overgrowth, ischemia, and inflammation.
Acute appendicitis may occur at any age but is more common in adolescents and young
adults. The classic symptom is abdominal pain that initially begins around the umbilicus
and later localizes to the right iliac fossa. This migration of pain occurs because early
visceral pain becomes localized when parietal peritoneal irritation develops.
Other symptoms include anorexia, nausea, vomiting, and low-grade fever. On examination,
patients may have tenderness at McBurney’s point, guarding, rebound tenderness, and
Rovsing’s sign. In advanced cases, generalized peritonitis may occur.
Diagnosis is mainly clinical but investigations are useful in supporting the diagnosis and
excluding other conditions. Laboratory findings may show leukocytosis with neutrophilia.
Urinalysis is often performed to exclude urinary tract pathology. Imaging studies such as
abdominal ultrasound and CT scan can improve diagnostic accuracy.
Differential diagnoses include gastroenteritis, ectopic pregnancy, pelvic inflammatory
disease, mesenteric adenitis, ovarian torsion, and renal colic. In female patients of
reproductive age, pregnancy testing is essential.
Management of acute appendicitis is primarily surgical. Appendicectomy may be performed
through open surgery or laparoscopic surgery. Laparoscopic appendicectomy is
increasingly preferred because it is associated with smaller scars, less postoperative pain,
and faster recovery.
Preoperative preparation includes intravenous fluids, analgesics, and antibiotics. Commonly
used antibiotics include ceftriaxone and metronidazole. Surgery should not be delayed
unnecessarily because perforation risk increases with time.
Complications of appendicitis include perforation, abscess formation, generalized
peritonitis, sepsis, and bowel obstruction. Perforated appendicitis may present with severe
abdominal pain, high fever, tachycardia, and signs of septic shock.
