Characterized for the first time as a surgical entity in 1886 by world-renowned pathologist Reginald Fitz, appendicitis now stands the most common abdominal clinical emergency, an appendectomy is a non-elective surgery most frequently performed by surgeons. Every year hundreds of thousands of cases are diagnosed in the United States alone, with that figure surpassing the ten million mark worldwide.
The condition known as appendicitis is nothing more than an inflammation of the appendix. This is typically caused by the development of an obstruction of the appendix itself at the end that is open and connected to the large intestine. More specifically, obstruction of the appendix is caused by three root causes: an inflammation of the lymphoid follicles; by the presence of a fecalith, or a small calcified stone of solidified fecal matter, that lodges at the exit of the appendix and generates a blockage; and finally, due to a tumor that obstructs the base of the appendix.
Regardless of the cause, the consequences of the obstruction generated are the same and follow the same pattern through several clinical phases, depending on how the inflammation evolves. In the first place a phlegmon, or localized area of acute inflammation, develops; subsequently, the appendix enters a gangrenous phase, in which the flow of blood becomes significantly diminished, and the tissue begins to experience cellular death; if left untreated, the final stage of appendicitis is perforation, which inevitably leads to the development of peritonitis.
However, not all phases are clearly established in all cases, and therefore, there are no clinical or paraclinical parameters that provide any degree of diagnostic certainty. As such, appendicitis continues to be a diagnostic challenge for the medical community.
Because of this problem, different diagnostic methods and assessment scores have been proposed that provide the medical community with a more precise diagnostic framework to enable more efficient therapeutic behavior. Additionally, clinical studies continue to report and analyze the usefulness and reliability of all potential diagnostic avenues. Given all this, it is imperative to learn as much as possible about the various manifestations of the different clinical symptoms associated with appendicitis.
The classic symptoms of appendicitis include:
Correctly interpreting abdominal pain is typically a rather challenging activity. In fact, few other clinical conditions demand more considerable judgment and interpretation from the clinical professional than abdominal pain, since even the most life-threatening conditions may be forecast by the subtlest of symptoms.
Therefore, when it comes to abdominal pain, it is imperative that a meticulous study of the patient’s symptomatology be carried out because in some cases, acute abdominal pain may not require surgical intervention, yet in others, even mild pain may belie an urgent condition that requires operative care.
There is a wide range of causes behind pain of the abdominal area, the most common being:
- Bacterial contamination
- Pelvic inflammatory disease
- Chemical irritation
- Mechanical obstruction of the small or large intestine
- Vascular rupture
The classic evolution of appendicitis, the most widely recognized, is that it begins with the appearance of pain near the navel, that then gradually migrates down towards the lower right part of the abdomen, where the appendix is located. Typically, the palpation of the abdomen is very painful, with the pain becoming significantly worse when the patient coughs, tries to walk, or makes any sudden movement with their bodies.
Pain is, by far, the most common symptom of appendicitis. However, it is important to clarify that according to the available diagnostic data, this “characteristic” pain only appears in half of all cases, and there are other symptoms that should be taken into account. The sooner you identify these, the easier it will be to treat the condition.
Up until very recently, it was thought that appendicitis invariably involves surgical removal of the appendix. However, there is growing evidence indicating that early treatment with antibiotics might prove a viable non-surgical alternative. Therefore, it is of paramount importance to consult with your doctor if you present acute abdominal pain, especially if it is accompanied by the following symptoms.