• Inflammation of the vermiform appendix due to obstruction of its lumen commonly by fecal matter, swollen lymphoid tissue, or rarely a foreign body.

• It often requires emergency abdominal surgery.

• Obstruction in the appendix lumen leading to elevated pressure, reduced blood flow, bacterial overgrowth, resulting in inflammation and infection.

• Children and young adults (10 – 30 years old).
• Slightly higher prevalence in males.

• Genetic predisposition increases the risk.

• Crohn’s disease, cystic fibrosis, inflammatory bowel disease, and conditions causing fecal matter accumulation or lymphoid hyperplasia.

• Obstruction causes distension and increased intraluminal pressure, which compromises blood flow and leads to ischemia.

• Elevated intraluminal pressure compromises blood flow, leading to ischemia and further inflammation.

• Persistent obstruction allows gut bacteria to invade the appendix wall, causing infection and inflammation.

• 1. Obstruction of the appendix lumen.
• 2. Increased intraluminal pressure and distension.
• 3. Compromised blood flow leads to ischemia.
• 4. Bacterial invasion causes infection and inflammation.
• 5. Uncontrolled inflammation results in tissue necrosis with a risk of perforation.

• Peritonitis, which is inflammation of the peritoneum and is potentially life-threatening if untreated.

• Can lead to perforation causing peritonitis and other serious complications.

• Obstruction, intussusception, hernia, cholecystitis, peptic ulcer perforation, diverticulitis, mesenteric adenitis, Crohn’s disease, pancreatitis, gastroenteritis, colon carcinoma.

• Testicular torsion, renal calculi (kidney stones), urinary tract infection (UTI).

• Ectopic pregnancy, ovarian torsion, ovarian rupture, ovarian cysts, pelvic inflammatory disease (PID).

• Approximately 70 to 80 cases per 100,000 people per year.

• Adolescents and young adults, especially those between 10 to 30 years old.

• Yes, it is more common in males than females.

• 10-20% of appendectomies involve removing a normal appendix.

• About 10% of the population will experience acute appendicitis at some point in their lives.

• Abdominal pain starting around the umbilicus, migrating to the right lower quadrant (RLQ), worsened by movement.
• Loss of appetite, nausea, vomiting, and low-grade fever.

• The pain gradually starts around the umbilicus and migrates to the RLQ, becoming more intense and worsened by movement.

• Tenderness at McBurney’s point.
• Rovsing’s sign (pain in RLQ when pressing on the left side).
• Psoas sign (pain on extending the right thigh).
• Obturator sign (pain on internal rotation of the hip).

• The Alvarado score helps assess the likelihood of appendicitis:
• Score 0-3: Appendicitis less likely.
• Score 9-12: Suggests the need for surgical exploration.

• Atypical symptoms may include indigestion, flatulence, bowel irregularity, diarrhea, and generalized malaise.

• Medical history and physical examination.
• Blood tests: Full blood count (FBC) and inflammatory markers like C-reactive protein (CRP).
• Imaging studies: Ultrasound (US) and computed tomography (CT) scans.

• FBC: Typically shows neutrophil-predominant leucocytosis.
• CRP: May be elevated but not always.

• To exclude pregnancy and other causes of right iliac fossa pain.
• May show mild leucocytosis but no nitrites.

• Ultrasound (US): First-line in children, young people, and pregnant women to avoid radiation exposure.
• CT scan: Preferred in adults for its high diagnostic accuracy though used cautiously due to radiation concerns.
• MRI: Used in pregnant women when ultrasound is inconclusive.

• Preferred in adults for its high diagnostic accuracy.
• Low-dose CT: Considered to reduce radiation exposure while maintaining diagnostic clarity.

• Reserved for pregnant women when ultrasound results are non-diagnostic.

• Based on patient’s age, gender, body habitus, and likelihood of appendicitis.
• Ultrasound is particularly useful in females with suspected pelvic pathology.

• Appendectomy: Surgical removal of the appendix is the standard treatment.

• Laparoscopic Appendectomy: Preferred due to quicker recovery and reduced hospital stay.
• Open Appendectomy: Alternative option particularly in complicated cases.

• Prophylactic IV Antibiotics: Used to reduce surgical site infection rates.
• Perforated Appendicitis: Managed with IV antibiotics; may include drainage or immediate surgery based on the patient’s stability.

• Antibiotic-Only Treatment: Considered in some cases though it has a higher recurrence rate and remains controversial.

• Increased Use of Antibiotic-First Approach: Adopted due to concerns over surgery during the pandemic.

• Diagnostic Uncertainty: Active observation is considered when the diagnosis of appendicitis is unclear.

• Intravenous Fluids and Proper Analgesia: Crucial for maintaining hydration and managing pain.

• Generally excellent with timely treatment.

• Appendix rupture, peritonitis, abscess formation.

• Non-perforated: 0.8 per 1000.
• Perforated: 5.1 per 1000.

• Mortality >20% in patients over 70 years due to subtle symptoms, rapid progression, and comorbidities.

• Appendix rupture, peritonitis, abscess formation, appendix mass, paralytic ileus.

• Intestinal obstruction, sepsis.

• Progression to local ischemia, perforation, and abscess formation. Peritonitis if the appendix ruptures.