Appendicitis

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[edit] Discussion

  • Acute appendicitis is one of the most common causes of acute abdominal pain.
  • It is the most common condition that requires abdominal surgery in childhood.
  • It is the most common condition associated with lawsuits against emergency physicians.


  • Acute appendicitis occurs when the appendiceal lumen is obstructed, leading to fluid accumulation, luminal distention, inflammation, and, finally, perforation.
  • Clinically and laboratory:
    • Periumbilical pain that shifts to the right lower quadrant
    • Nausea, vomiting, and anorexia
    • Rebound tenderness
    • Leukocytosis (seen in approx 80% of patients with appendicitis)
  • Complications:


  • Although appendicitis traditionally has been a clinical diagnosis, many patients are found to have normal appendixes at surgery.
  • A rate of unnecessary removal as high as 20% has been considered acceptable in the surgery literature. However, negative laparotomy can be avoided in many patients if modern diagnostic methods are used to confirm or exclude acute appendicitis.

[edit] Imaging Findings

[edit] CT

  • Appendiceal thickening with the outer-wall-to-outer-wall transverse diameter greater than 6 mm.
    • Some authors define appendiceal thickening on CT as transverse diameter greater than 7 mm
    • The appendiceal diameter probably should be interpreted in the context of clinical and other
  • Appendiceal wall thickening (wall ≥ 3mm)
    • Appendiceal wall hyperenhancement
    • Mural stratification of the appendiceal wall
    • Appendicolith(s) (present in one third of patients with appendicitis).
  • Cecal apical thickening (diffuse as opposed to apical cecal thickening is also possible, but this is less specific for appendicitis).
  • Periappendiceal inflammation includes periappendiceal fat stranding, thickening of the lateral conal fascia, and mesoappendix, extraluminal fluid, phlegmon, abscess, ileocecal mild lymph node enlargement, and inflammatory thickening of contiguous structures.

[edit] Images

Patient #1: Right lower quadrant pain

Patient #2: Right lower quadrant pain

Patient #3: Right lower quadrant pain

[edit] See Also

[edit] External Links

[edit] References