Acute appendicitis in adults

Ketan Vagholkar


Acute appendicitis is one of the commonest abdominal emergency encountered by a general surgeon. Understanding the surgical pathology is pivotal in identifying the stage of disease at which the patient presents for better correlation of clinical features, laboratory and imaging reports. Various scoring systems enhance and aid this process. Imaging confirms the diagnosis. Early diagnosis is essential to prevent complications. Surgery is the mainstay of treatment. Appendicitis may present in various forms in different clinical settings. A uniform approach to presentations may not always yield good results. Though appendectomy is the mainstay of treatment yet a tailor made surgical plan needs to be developed after holistic evaluation of the patient. The article discusses the differential surgical approach based on the etiopathogenesis, diagnosis and variable clinical presentations.


Acute appendicitis, Diagnosis, Scoring, Treatment

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Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012;10:115-9.

Alfredo A. Clinical approach in the diagnosis of acute appendicitis, current issues in the diagnostics and treatment of acute appendicitis. 2018. Available at: Accessed on 01 June 2020.

Gurleyik G, Gurleyik E. Age related clinical features in older patients with acute appendicitis. Eur J Emerg Med. 2003;10(3):200-3.

Petroianu A, Alberti L, Zac RI. Assessment of the persistence of fecal loading in the cecum in presence of acute appendicitis. Int J Surg. 2007;5:11-6.

Vagholkar K, Pawanarkar A, Vagholkar S, Pathan K. Amyand’s hernia: a need for greater surgical awareness. Int J Adv Med. 2016;3:145-7.

Vagholkar K, Pawanarkar A, Vagholkar S, Pathan K, Pathan S. De Garengeot’s hernia: a surgical surprise. Int Surg J. 2016;3:471-2.

Singla A, Rajaratman J, Singla AA. Unusual presentation of left sided appendicitis in elderly male with asymptomatic midgut rotation. Int J Surg Case Rep. 2015;17:42-4.

Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr. 2017;43:15.

Buzatti KC, Goncalvez MV, Da Silva R, Rodrigues BP. Acute appendicitis mimicking acute scrotum: a rare complication of a common abdominal inflammatory disease. J Coloproctol. 2018;1:65-9.

Carmignani CP, Ismail S, Ganz J, Kalan MMH. Retroperitoneal necrotizing soft tissue infection after appendicitis. Surgical Rounds. 2005:283-4.

Sharma SB, Gupta V, Sarma SC. Acute appendicitis presenting as thigh abscess in a child: a case report. Pediatr Surg Int. 2005;21(4):298-300.

Wani I. K-sign in retrocecal appendicitis: a case review series. Cases J. 2009;2:157.

Tamir IL, Bongard FS, Klein SR. Acute appendicitis in the pregnant patient. Am J Surg. 1990;160(6):571-5.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergence Medicine. 1986;15(5):557-64.

Tade AO. Evaluation of Alvarado score as an admission criterion in patients with suspected diagnosis of acute appendicitis. West Af J Med. 2007;26(3):210-12.

Scott AJ, Mason SE, Arunakirinathan M, Reissis Y, Kinross JM, Smith JJ. Risk stratification by the appendicitis inflammatory response score to guide decision-making in patients with suspected appendicitis. Br J Surg. 2015;102(5):563-72.

Kollár D, McCartan DP, Bourke M, Cross KS, Dowdall J. Predicting acute appendicitis? A comparison of the Alvarado score, the appendicitis inflammatory response score and clinical assessment. World J Surg. 2015;39(1):104-9.

Debnath J, George RA, Ravikumar R. Imaging in acute appendicitis: what, when, and why. Med J Armed Forces India. 2017;73:74-9.

Bin Ismail HM, Malik A. Will plain abdominal x-ray become obsolete?. Open J Radiol. 2017;2(2):32-7.

John H, Neff U, Kelemen N. Appendicitis diagnosis today: clinical and ultrasound deductions. World J Surg. 1993;17:243-9.

Chiang DT, Tan EI, Birks D. To have or not to have: should computed tomography and ultrasonography be implemented as a routine in patients with suspected appendicitis in a regional hospital?. Annals of the Royal College of Surgeons of England. 2008;90:17-21.

Ong EMW, Venkatesh K. Ascending retrocecal appendicitis presenting with right upper abdominal pain: utility of computed tomography. World J Gastroenterol. 2009;15(28):3576-9.

Konrad J, Grand D, Lourenco A. MRI: first-line imaging modality for pregnant patients with suspected appendicitis. Abdominal Imaging. 2015;40(8):3359-64.

Lim SG, Ahn EJ, Kim SY, Chung IY, Park JM, Park SH, Choi KW. A clinical comparison of laparoscopic versus open appendectomy for complicated appendicitis. J Korean Soc Coloproctol. 2011;27:293-7.

Markar SR, Venkat-Raman V, Ho A, Karthikesalingam A, Kinross J, Evans J, Bloom I. Laparoscopic versus open appendicectomy in obese patients. Int J Surg. 2011;9:451-5.

Cariati A, Brignole E, Tonelli E, Filippi M, Guasone F, De Negri A, Novello L, Risso C, Noceti A, Giberto M, Giua R. Laparoscopic or open appendectomy: critical review of the literature and personal experience. G Chir. 2001;22:353-7.

Navez B, Therasse A. Should every patient undergoing laparoscopy for clinical diagnosis of appendicitis have an appendicectomy?. Acta Chir Belg. 2003;103:87-9.

Vettoretto N, Agresta F. A brief review of laparoscopic appendectomy: the issues and the evidence. Tech Coloproctol. 2011;15:1-6.

Pearl J, Price R, Richardson W, Fanelli R. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2011;25:3479-92.

Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN, Lustik MB, Yamamura MS, Matayoshi EZ, Zagorski SM. Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc. 2011;25:2678-83.

Gill RS, Shi X, Al-Adra DP, Birch DW, Karmali S. Single incision appendectomy is comparable to conventional laparoscopic appendectomy: a systematic review and pooled analysis. Surg Laparosc Endosc Percutan Tech. 2012;22:319-27.

Huang C, Huang RX, Qiu ZJ. Natural orifice transluminal endoscopic surgery: new minimally invasive surgery come of age. World J Gastroenterol. 2011;17:4382-8.

Jaunoo SS, Hale AL, Masters JP, Jaunoo SR. An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix. Ann R Coll Surg Engl. 2012;94:476-80.

Van Vlodrop V, Pattyn P, Ceelen W. Management of the ‘normal’ appendix during surgery for right fossa syndrome: proposed clinical algorithm. Acta Chir Belg. 2007;107:8-11.

Jahadi MR, Shaw ML. The pathology of the appendix in ulcerative colitis. Dis Colon Rectum. 1976;19:345-9.

Subramanian A, Liang MK. A 60-year literature review of stump appendicitis: the need for a critical view. Am J Surg. 2012;203(4):503-7.

Bu-Ali O, Al-Bashir M, Samir HA, Abu-Sidan FM. Stump appendicitis after laparoscopic appendectomy: casereport. Ulusal Travmave Acil Cerrahi Dergisi. 2011;17(3):267-8.