Management of complex appendicitis

Acute appendicitis is the commonest abdominal surgical emergency with a lifetime incidence of just under 7.6%. It is most common in patients under the age of 30 years. Appendicitis is thought to occur after occlusion of the appendix orifice. The diagnosis is usually made clinically but the clinical findings vary widely with only half the patients presenting with classical clinical findings. The diagnosis is more difficult at extremes of age and where there is uncertainty, laboratory investigations, radiological investigations or diagnostic laparoscopy are of use. If the presentation is delayed, patients may present with a perforated appendix, an appendix mass or abscess. Appendicectomy may be performed via the open or laparoscopic techniques. Laparoscopic appendicectomy is increasing in popularity with increasing use of diagnostic laparoscopy and increasing surgeon skills. The most common complication following appendicectomy is wound infection with an overall incidence of about 15%.