Acute Appendicitis in Childhood and Adulthood

Abstract

Background: Acute appendicitis is the most common cause of the acute abdomen, with an incidence of 1 per 1000 persons per year. It is one of the main differential diagnoses of unclear abdominal conditions.

Methods: This review is based on pertinent publications that were retrieved by a selective search in the PubMed and Cochrane Library databases.

Results: In addition to the medical history, physical examination and laboratory tests, abdominal ultrasonography should be performed to establish the diagnosis (and sometimes computed tomography [CT] or magnetic resonance imaging [MRI], if ultrasonography is insufficient). Before any treatment is provided, appendicitis is classified as either uncomplicated or complicated. In both types of appendicitis, the decision to treat surgically or conservatively must be based on the overall clinical picture and the patient's risk factors. Appendectomy is the treatment of choice for acute appendicitis in all age groups. In Germany, appendectomy is mainly performed laparoscopically in patients with low morbidity. Uncomplicated appendicitis can, alternatively, be treated conservatively under certain circumstances. A meta-analysis of five randomized, controlled trials has revealed that ca. 37% of adult patients treated conservatively undergo appendectomy within one year. Complicated appendicitis is a serious disease; it can also potentially be treated conservatively (with antibiotics, with or without placement of a drain) as an alternative to surgical treatment.

Conclusion: Conservative treatment is being performed more frequently, but the current state of the evidence does not justify a change of the standard therapy from surgery to conservative treatment.

Figure

A diagram of the pain and pressure points to be checked when acute appendicitis is suspected.

Figure 1

Intraoperative view of gangrenous appendicitis a) after exposure and b) before removal with a stapler. Arrow: base of appendix; polygon: tip of appendix; line: parallel to the dissector with which the surgeon is checking the freely exposed window of the mesoappendix.

eFigure 1

a) intraoperative view a) before and b) after exposure. Arrow: base of appendix; polygon: tip of appendix, star: mesoappendix; white border: window created in the mesoappendix.

eFigure 2

intraoperative view after a) clipping and b) division of the main structures. Arrow: base of appendix; polygon: tip of appendix, star: mesoappendix; rectangle: appendicular artery.