Acute appendicitis

Acute appendicitis is the most common abdominal emergency and the overall lifetime risk in the UK is between 6% and 20%. The exact cause remains unclear, but luminal obstruction, diet and familial factors have been suggested, and the aetiology may be multifactorial in some cases. Inflammation of the appendix ranges from minor, simple acute inflammation to suppurative necrosis and perforation. The findings of history and examination can vary widely, and only about one-half of patients with acute appendicitis have a ‘classical’ presentation. Age can influence presentation and, because the appendix is a relatively mobile structure, the clinical picture is also dictated by the anatomical position of the inflamed organ. Due to the variability in presentation, there is a wide range of differential diagnoses when suspecting acute appendicitis and, although blood and radiological investigations may be requested, the diagnosis is often clinical. The first-line treatment for acute appendicitis in the UK is appendicectomy, which can be performed as an open procedure or laparoscopically. Wound infection is the most common complication of appendicectomy and rates vary according to the stage of disease and the degree of surgical contamination.