Appendicitis

Abstract

Appendicitis is one of the most common causes of acute abdominal pain worldwide, and expertise in the treatment of acute appendicitis and in performing appendectomy are essential to the general surgical practice. However, despite significant experience with the diagnosis and treatment of appendicitis, our understanding of the pathogenesis of the disease, as well as insights into optimal treatment strategies, continue to evolve. Current thinking indicates that the pathophysiology of acute appendicitis involves luminal obstruction leading to distension, bacterial overgrowth, and venous congestion. Suspicion for this process is raised based on a history of acute abdominal pain localizing to the right lower quadrant with tenderness, and the diagnosis is typically confirmed preoperatively with ultrasound, CT scans or MRI. The current standard of care for treating non-perforated, acute appendicitis is appendectomy, and the minimally invasive approach reliably achieves excellent outcomes. However, emerging evidence suggests that in selected cases, appendicitis could be treated with antibiotics alone, although many cases will still require appendectomy eventually. In the presence of perforation, the treatment will vary based on the patient’s stability and presence of abscess formation, and the ability to achieve source control. This chapter reviews the current understanding and treatment of appendicitis and considers special patient situations and current controversies in the management of this common and occasionally challenging disease.