Clinical Review

Acute appendicitis

BMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.38940.664363.AE (Published 07 September 2006) Cite this as: BMJ 2006;333:530
  1. D J Humes, Research into Ageing/Royal College of Surgeons of England research fellow1,
  2. J Simpson, lecturer in surgery (j.simpson@nottingham.ac.uk)1
  1. 1 Division of Gastrointestinal Surgery, Section of Surgery, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH
  1. Correspondence to: J Simpson
  • Accepted 7 August 2006

Introduction

The diagnosis of acute appendicitis is predominantly a clinical one; many patients present with a typical history and examination findings. The cause of acute appendicitis is unknown but is probably multifactorial; luminal obstruction and dietary and familial factors have all been suggested.1 Appendicectomy is the treatment of choice and is increasingly done as a laparoscopic procedure. This article reviews the presentation, investigation, treatment, and complications of acute appendicitis and appendicectomy.

How common is appendicitis?

Appendicitis is the most common abdominal emergency and accounts for more than 40 000 hospital admissions in England every year.2 Appendicitis is most common between the ages of 10 and 20 years, but no age is exempt.3 A male preponderance exists, with a male to female ratio of 1.4:1; the overall lifetime risk is 8.6% for males and 6.7% for females in the United States.3 Since the 1940s the incidence of hospital admission for acute appendicitis has been falling, but the reason for this decline is not clear.w1

How do I diagnose it?

Diagnosis of acute appendicitis relies on a thorough history and examination.w2

History

Abdominal pain is the primary presenting complaint of patients with acute appendicitis. The diagnostic sequence of colicky central abdominal pain followed by vomiting with migration of the pain to the right iliac fossa was first described by Murphy but may only be present in 50% of patients.4 Typically, the patient describes a peri-umbilical colicky pain, which intensifies during the first 24 hours, becoming constant and sharp, and migrates to the right iliac fossa. The initial pain represents a referred pain resulting from the visceral innervation of the midgut, and the localised pain is caused by involvement of the parietal peritoneum after progression of the inflammatory process. Loss of appetite is often a predominant feature, and constipation and nausea are often present. Profuse vomiting may …

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