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Key Points
Inflammation of the appendix is a significant public health problem with a lifetime incidence of 8.6% in men and 6.7% in women, with the highest incidence in the second and third decade of life.6 While the rate of appendectomy in developed countries has decreased over the last several decades, it remains one of the most frequent emergent abdominal operations.
The natural history of appendicitis is unclear, but it appears that progression to perforation is not predictable and that spontaneous resolution is common, suggesting that nonperforated and perforated appendicitis may, in fact, be different diseases.
C-reactive protein, bilirubin, Il-6, and procalcitonin have all been suggested to be helpful in the diagnosis of appendicitis, specifically in predicting perforated appendicitis.
Perforated appendicitis can be managed either operatively or nonoperatively. Immediate surgery is necessary in patients that appear septic, but this is usually associated with higher complications, including abscesses and enterocutaneous fistulae, due to dense adhesions and inflammation.
Single incision appendectomy has not been shown to improve outcomes, including cosmetic outcomes, in prospective randomized studies and has been suggested to have a higher incisional hernia rate.
While there is no evidence clearly evaluating long-term outcomes of patients undergoing incidental appendectomy with an asymptomatic appendix, the risk of adhesions and future complications after an appendectomy has been suggested to be higher than the risk of future appendicitis and increased economic costs. An incidental appendectomy is currently not advocated.
Older adult patients are at a higher risk for complications due to their premorbid conditions, and it is prudent to obtain definitive diagnostic imaging prior to taking patients to the operating room.
Patients with uncomplicated appendicitis do not require further antibiotics after an appendectomy, while patients with perforated appendicitis are treated with 3 to 7 days of antibiotics.
The most common mode of presentation for appendiceal carcinoma is that of acute appendicitis. Patients also may present with ascites or a palpable mass, or the neoplasm may be discovered during an operative procedure for an unrelated cause.
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Although anatomists such as Vesalius and Leonardo Da Vinci had written about the appendix, Claudius Amyand in the early 18th century was the first surgeon to describe a successful appendectomy.1 In subsequent centuries, significant progress was made in the diagnosis and management of appendicitis, especially after Chester McBurney advocated for early appendectomy in his 1889 publication.2 Famously, the magician Harry Houdini died of a ruptured appendix after suffering a blow to his abdomen. Following the introduction and widespread use of antibiotics in the 1940s, mortality rates improved further. In 1982, Kurt Semm, a gynecologist, reported on the first laparoscopic appendectomy, which is now the most widely adopted technique.
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EMBRYOLOGY, ANATOMY, AND HISTOLOGY
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Previously considered a vestigial organ, the appendix is now linked to the development and preservation of gut-associated lymphoid tissue (GALT) and to the maintenance of intestinal flora. ...