Clinical Presentation

Acute appendicitis (and its complications) is among the most common surgical emergencies encountered. Classically it presents initially with vague, colicky central abdominal (periumbilical) pain which is associated with vomiting and anorexia. When the inflammation becomes transmural a localised peritonitis is illicited and the pain becomes sharp in nature, localised in the right iliac fossa and associated with pyrexia. Palpation reveals signs of localised peritonitis in the vicinity of McBurney's point.

As was stated above, the position of the body and tip of the appendix is variable and so the nature of the symptoms and signs will vary accordingly - e.g., flank pain and tenderness in retro-caecal appendicitis. Although perforation of the appendix usually remains localised (due to "walling off' by the greater omentum) occasionally it may lead to a generalised peritonitis.

The list of differential diagnoses for acute appendicitis is myriad and includes ectopic pregnancy, torsion of an ovarian cyst, Meckel's diverticulitis, urinary tract infection, terminal ileitis, endometriosis, etc.

An appendiceal abscess (which usually develops three days after a bout of acute appendicitis) can usually be palpated by a combination of abdominal and rectal examination. Differential diagnoses of an appendiceal mass also include carcinoma of the caecum, Crohn's terminal ileitis and ovarian carcinoma.

0 0

Post a comment