Key Points
ÎAppendicitis affects approximately 300,000 patients/year and consumes over 1 million hospital days in the US. Lifetime risk is 8.6% for males and 6.7% for females. In 2005, patients with abdominal pain composed 6.8% of 115 million annual emergency department visits.
ÎAppendicitis typically begins with luminal obstruction from inspissated fecal matter or lymphoid hyperplasia and progresses to perforation at a rate of approximately 5-10%/24 hours after the first 24 hours.
ÎIn young, preverbal toddlers, the risk of perforation at the time of appendicitis diagnosis is high. In children younger than 4 years, appendiceal perforation occurs in the vast majority of cases, with rates reported as high as 80% to 100%. In contrast, appendicitis in children aged 10 to 17 years is more common, but the perforation rate is much lower (10%-20%).
ÎAppendicitis is generally diagnosed by a constellation of history and physical exam findings and limited laboratory evaluations.
ÎDiagnostic imaging is used to confirm the diagnosis in most women and children, and frequently in men as well.
ÎMost patients with acute appendicitis can be safely managed with laparoscopic or open appendectomy.
ÎSelected patients with periappendiceal abscess or phlegmon, and selected patients with acute, nonperforated appendicitis can be safely managed nonoperatively with antimicrobial therapy alone.
ÎAntimicrobial therapy is important in preventing the complications of acute appendicitis, including both surgical site infections and deep organ space abscesses.
ÎAntimicrobial therapy should be initiated preoperatively in all patients undergoing operative appendectomy. Antimicrobial therapy should be discontinued within 24 hours in patients with acute, nonperforated appendicitis.
ÎPatients with perforated appendicitis and patients being managed nonoperatively should receive antimicrobial therapy according to the general principles outlined for management of patients with complicated intra-abdominal infection.
