Diagnosis and Treatment of Appendicitis

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Inflammation occurs when the appendix becomes infected or blocked. Blockages can be the result of:. An early symptom of appendicitis is pain, often in the center of the abdomen but sometimes on the right side. The pain may be dull at first, but may become more sharp or severe. Accompanying symptoms may include slight fever above normal but less than degrees , vomiting or nausea.

Appendicitis - The only video you will need!

Appendicitis can be difficult to diagnose because a number of other conditions can cause similar symptoms. Not everyone with appendicitis exhibits all of these symptoms. If you have any of these symptoms, particularly abdominal pain that continues to worsen, contact your doctor immediately.

Appendicitis - symptoms, diagnosis, surgery, recovery

For information about ultrasound procedures performed on children, visit the Pediatric Abdominal Ultrasound page. The most common treatment for appendicitis is an appendectomy, or surgery to completely remove the appendix. However, in some patients, the appendix can rupture and lead to an abscess , or collection of pus. If this is the case, your doctor may recommend having a percutaneous abscess drainage procedure to remove the fluid from your body in addition to undergoing an appendectomy. Patients who undergo percutaneous abscess drainage will remain hospitalized for a few days.

Follow up is usually done on an outpatient basis and you will be seen by your interventional radiologist to make sure healing is proceeding according to plan.

Appendicitis

Please type your comment or suggestion into the text box below. Note: we are unable to answer specific questions or offer individual medical advice or opinions. Some imaging tests and treatments have special pediatric considerations. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician. To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database.

Acute Appendicitis: Efficient Diagnosis and Management - American Family Physician

This website does not provide cost information. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the Radiological Society of North America RSNA and the American College of Radiology ACR , comprising physicians with expertise in several radiologic areas. Outside links: For the convenience of our users, RadiologyInfo.

Clinical Evaluation

Toggle navigation. Appendectomy is still considered to be the gold standard for uncomplicated appendicitis.

Two main approaches to remove an inflamed appendix are available; the open approach OA or the laparoscopic approach LA. It was stated that LA was associated with fewer superficial wound infections, less post-operative pain, shorter hospital stay and earlier return to work, but the higher rate of IAA raised concerns [ 52 ]. Ever since, inconsistent results have been reported regarding the potential higher incidence of IAA after LA [ 53 — 61 ]. Benefits of LA over OA reported in meta-analyses are: reduced incidence of SSI, post-operative and long-term bowel obstruction with better outcome in terms of shorter hospital stay, its diagnostic value, less pain, earlier return to work, earlier start of oral intake, improved scar and body satisfaction and fewer incisional hernias [ 54 , 55 , 58 , 61 — 66 ].

Disadvantages besides the possible higher incidence of IAA are longer operating time and possibly increased costs [ 58 , 63 ]. To reduce the surgical trauma even more, new treatment strategies have been introduced such as single-incision laparoscopic surgery SILS first reported by Pelosi et al. It can be concluded that SILS is associated with comparable post-operative morbidity rates compared to conventional LA [ 68 — 70 ].

The disadvantage is the fact that SILS is a more difficult technique as is reflected by the higher technical failure rate, longer operating time and conversion rate [ 71 — 78 ]. Main advantages of SILS would be less post-operative pain and better cosmetic outcomes, although inconsistent results have been reported [ 71 , 75 , 76 , 79 — 81 ]. SILS is, however, a safe and feasible alternative. Recently, initial non-operative management of appendicitis has been investigated in the adult population.

Opponents of this strategy raise concerns such as recurrent appendicitis, missing an underlying malignancy and progression of uncomplicated into complicated appendicitis. Due to the possible avoidance of surgery with an initial non-operative treatment strategy, morbidity was diminished [ 91 , 93 , 95 ]. However, both RCTs and meta-analyses showed significant heterogeneity of methodological quality, studies included and definitions of outcome parameters.

Until higher qualitative evidence has been obtained regarding the potential benefits of initial non-operative management of acute appendicitis and the potential long-term effects have been investigated appropriately, appendectomy remains the gold standard in acute uncomplicated appendicitis. Due to the heterogeneity of the definitions used in the literature, it is difficult to draw firm conclusions regarding the treatment of complicated appendicitis. In , Dimitriou published a retrospective cohort study on patients with complicated appendicitis defined as perforated with an abscess or peritonitis.

A RCT encompassing 81 patients with clinically and histopathologically confirmed complicated appendicitis showed similar outcomes after OA and LA [ 97 ]. It should be noted, however, that the incidence of IAA after LA for patients with complicated appendicitis was reported to be higher in some studies. Tuggle and colleagues reported that LA in patients with complicated appendicitis was associated with an incidence of IAA of 6.

The incidence of small bowel obstructions after LA is lower compared to OA pooled odds ratio 0. In case of a contained phlegmon or abscess peri-appendicular mass , some authors opt for non-operative treatment while others advocate aggressive operative treatment. In , Andersson et al. Similis et al. It must be mentioned that this meta-analysis was subject to large heterogeneity [ ]. Recent cohort studies draw opposite conclusions [ , ]. They opt for a more aggressive surgical approach at time of presentation in case of an appendicular mass or appendicular abscess, based upon the idea that there is a relative high failure rate for non-surgical treatment [ , ].

In our opinion, with this new evidence, a new systematic review should be performed. Until then, initial non-operative treatment of an appendicular mass of appendicular abscess is the preferred treatment of choice. Although not covered in this consensus guideline, the value of interval appendectomy after initial non-operative treatment of an appendicular mass is still subject of debate.

Both can be avoided with an interval appendectomy, although data are lacking on its benefits.


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Abdominal surgery in obese patients is challenging for both the anaesthesiologist and surgeon due to higher incidence of respiratory dysfunction, difficult access to the abdominal cavity, blurred anatomical landmarks and reduced working space in the abdominal cavity. Clarke et al. This was confirmed by a meta-analysis, although a reduced length of hospital stay was noted after LA [ ].

More recently, two recent meta-analyses showed a reduction of mortality and morbidity rates after LA [ , ]. Pregnancy induces anatomical and physiological changes that challenge the surgeon. The potential effects of carbon dioxide and increased abdominal pressure during LA on the foetus remain unclear. Loss of the foetus is most feared.

In , Walsh et al. Another review confirmed these findings and reported a nearly twofold increase of foetal loss in the LA group [ ]. Both reviews, however, are mainly dominated by one study and based on low-grade evidence retrospective studies with small numbers of patients [ — ]. Recently, a review suggested that based upon the little available evidence no recommendation can be made regarding the preferred approach in pregnant patients [ ]. More studies are necessary to ascertain the role of laparoscopic surgery during pregnancy. Based upon expert opinion, we recommend laparoscopy in case of sufficient experience.

Although not supported by the literature, we strongly advise a multi-disciplinary approach to the pregnant patient with appendicitis [ 13 , 54 , 82 , , ]. One meta-analysis included , children with both uncomplicated and complicated appendicitis [ ].

Signs and symptoms of appendicitis
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