Appendicitis

Appendicitis is the most common abdominal emergency and accounts for more than 40000 hospital admissions in England every year (approximately 1 per 1500 population) 1 Appendicitis is most common between the ages of 10 and 20 years, but no age group is exempt There is a male to female ratio of 1.4:1; overall lifetime risk is 8.6% for males and 6.7% for females in the United States 2 Since the 1940s the incidence of hospital admission for acute appendicitis has been falling, but the reason for this decline is not clear 3 Why is appendicitis missed? Appendicitis is a progressive inflammatory process, and the incidence of perforated cases rises with the duration of symptoms. [...]prompt diagnosis and treatment are essential for reducing the increased risk associated with advanced inflammation. In the assessment of a patient with suspected appendicitis, studies have demonstrated that pain migration (positive likelihood ratio 2.06) and evidence of peritoneal irritation (localised direct or indirect tenderness (1.29-2.47), rigidity (2.96), guarding (2.48), rebound (1.99), and percussion tenderness (2.86) are the most useful clinical findings associated with a positive diagnosis. 11 Abdominal pain is the primary presenting complaint of patients with acute appendicitis. All patients should receive broad spectrum perioperative antibiotics as this decreases the incidence of postoperative wound infections and abscess formation. 17 Key points Appendicitis is a predominantly clinical diagnosis, and no single individual symptom or sign can be relied upon to diagnose or exclude it A history of fever or pain migration and evidence of peritoneal irritation have been found to be the most useful clinical features in making the diagnosis A raised CRP and white cell count can support the diagnosis The classical presentation can be influenced by the age of the patient and anatomical position of the appendix Contributors: SRRL and JS wrote the first draft.