Acute appendicitis

Acute appendicitis is the most common surgical emergency, and appendectomy is the most common emergency operation, with more than 250,000 procedures reported annually in the United States. Acute appendicitis results from appendiceal endoluminal obstruction, typically caused by a fecalith. Although no specifi risk factors have been identifid, it is slightly more common in males and in the young and the elderly, with more advanced disease on presentation in the elderly. Clinical fidings in combination with basic laboratory tests are often enough to establish
the diagnosis, and imaging studies, such as abdominal ultrasound or computed tomography (CT), can be helpful to confim the diagnosis and rule out other potential pathologies in selected individuals. The treatment for acute appendicitis is appendectomy, and the laparoscopic approach is preferred, given its association with better postoperative outcomes. In later stages, appendicitis may be complicated with phlegmon or intraabdominal abscess. For these patients, aggressive medical treatment with broad-spectrum antibiotics and percutaneous drainage when indicated is the initial treatment of choice, and the operative approach is reserved for when this treatment fails and in the setting of peritonitis. Interval appendectomy after an episode of appendicitis treated with antibiotics, although still controversial, must be considered to minimize the risk of recurrent inflmmation, which is associated with worse outcomes.
Good outcomes are generally seen in patients diagnosed and treated early, and this should be the main goal when approaching patients with suspected acute appendicitis.