Summary
Definition
Acute appendicitis is an acute inflammation of the vermiform appendix, most likely due to obstruction of the lumen of the appendix (by faecolith, normal stool, infective agents, or lymphoid hyperplasia).[1][2][Figure caption and citation for the preceding image starts]: Acute appendicitis - intraoperative specimenNasim Ahmed, MBBS, FACS; used with permission [Citation ends].
History and exam
Key diagnostic factors
- abdominal pain
- anorexia
- nausea and vomiting
- right lower quadrant tenderness
- high’ or ‘intermediate’ risk score
- tense, rigid abdomen
- hypotension and tachycardia
- palpable mass
Other diagnostic factors
- age of occurrence
- low-grade pyrexia
- flushed face and a fetor
- reduced bowel sounds
- tachycardia
- loose stool
- constipation
- flexed right hip (psoas sign)
Diagnostic investigations
Treatment algorithm
Contributors
Expert advisers
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Biography
JA is Clinical Lead for General Surgery, Getting It Right First Time.
Disclosures
JA is trustee and council member of the Royal College of Surgeons of England.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:
Dileep N. Lobo, MS, DM, FRCS, FACS
Professor of Gastrointestinal Surgery
National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit
Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre
Nottingham
UK
DNL declares that he has no competing interests. DNL is an author of an article cited in the topic.
Peer reviewers
Sarah Richards
General Surgeon
Royal United Hospitals
Bath NHS Foundation Trust
UK
Biography
SR is a specialty advisor in emergency general surgery to the Royal College of Surgeons and an honorary senior clinical lecturer and examiner for the University of Bristol medical school.
Disclosures
SR declares that she has no competing interests.
Kokila Lakhoo, PhD, FRCS, FCS (Paediatrics) MRCPCH, MBCHB
Consultant Paediatric Surgeon
Children’s Hospital in Oxford and the University of Oxford
UK
Disclosures
KL declares that she has no competing interests.
References
Key articles
Di Saverio S, Podda M, de Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27.Full text Abstract
Gorter RR, Eker HH, Gorter-Stam MA, et al. Diagnosis and management of acute appendicitis: EAES consensus development conference 2015. Surg Endosc. 2016 Nov;30(11):4668-90.Full text Abstract
Association of Surgeons of Great Britain and Ireland; Royal College of Surgeons of England. Commissioning guide: emergency general surgery (acute abdominal pain). April 2014 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available here.
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