Acute appendicitis

Appendicitis is defined as inflammation of the vermiform appendix, the most common surgical emergency in children and young adults with abdominal pain. The current standard of care for patients with appendicitis is the surgical appendicectomy, either laparoscopic or open. A non-operative strategy with antibiotics is favourable in some cases and emerging evidence suggests there could be wider applicability. Diagnosis is based on history, clinical examination and laboratory tests, although 30–45% of patients exhibit atypical signs and symptoms on presentation. Where the diagnosis remains ambiguous, ultrasound and CT scans are the most widely used imaging modalities. Diagnostic laparoscopy can be a useful approach in low-risk patients, particularly young women. Appendicitis is classified into simple or complex disease, complex in the presence of a peri-appendicular abscess, gangrene or perforation. Complex appendicitis has significantly higher rates of morbidity and mortality. Limiting the progression from simple to complex disease, although not inevitable, is the rationale for early definitive treatment. An appendicectomy performed for suspected appendicitis resulting in a normal appendix on histopathological examination is referred to as a negative appendicectomy. A negative appendicectomy has a postoperative complication rate of around 10%, demonstrating the need for both accurate and timely diagnosis