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. 2025 Jan 30;40(1):28.
doi: 10.1007/s00384-024-04793-7.

Acute appendicitis and its treatment: a historical overview

Lucio Selvaggi #  1 , Francesco Pata #  2 , Gianluca Pellino  1   3 , Mauro Podda  4 , Salomone Di Saverio  5 , Giuseppe Massimiliano De Luca  6 , Pasquale Sperlongano  1 , Francesco Selvaggi  1 , Bruno Nardo  7
Affiliations

Acute appendicitis and its treatment: a historical overview

Lucio Selvaggi et al. Int J Colorectal Dis. .

Abstract

Purpose: Acute appendicitis (AA) is the leading cause of acute abdomen worldwide, with an incidence of 90-100 cases per 100,000 individuals annually and a lifetime risk of 7-12%. Despite its prevalence, historical accounts of AA are limited, particularly when compared to conditions like haemorrhoids, likely due to the appendix's internal location. This article traces the historical evolution of AA treatment from ancient times to the present, highlighting key contributions.

Methods: A review of common research databases and relevant literature on AA was conducted.

Results: Evidence from ancient Egypt suggests early recognition of the appendix, referring to it as the "worm of the bowel." However, detailed anatomical descriptions and treatment approaches for AA did not emerge until the Renaissance, particularly with contributions from Leonardo da Vinci and Berengario da Carpi. The article traces the progression of AA management, including the first autopsies and surgeries, the development of surgical techniques predating anaesthesia and antisepsis, and advancements achieved from the nineteenth to the twenty-first century. The shift from conservative to surgical approaches is discussed, alongside innovations such as laparoscopic appendicectomy, single-incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and endoscopic retrograde appendicitis therapy (ERAT). The impact of the COVID-19 pandemic on AA treatment, including adaptations in medical practices, is also explored.

Conclusions: This review highlights the significant historical developments in AA treatment and its pivotal role in advancing abdominal surgery.

Keywords: Acute appendicitis; Appendectomy; Appendicectomy; ERAT; Historical overview; History; History of medicine; Laparoscopic; Laparoscopy.

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Conflict of interest statement

Declarations. Conflict of interest: GP and FP are editors on this journal, but are recused from the Editorial peer review process of this article. None of the other authors has a conflict of interest to declare. Ethics approval and consent to participate: Not applicable. Disclaimer: The images from 1 to 17 that accompany the article are more than 75 years old and hence out with copyright rules. All sources have been attributed.

Figures

Fig. 1
Fig. 1
Leonardo Da Vinci (1452–1519), “The gastrointestinal tract, the stomach, liver and spleen” c. 1508 (Royal Collection) https://www.rct.uk/collection/. Public domain
Fig. 2
Fig. 2
Portrait of Berengario da Carpi (1460–1530), 1495 (Museum of Palazzo dei Pio, at Carpi, Italy). Public domain
Fig. 3
Fig. 3
Frontispiece of “Isagogae Breves 1522” (Wikipedia) https://upload.wikimedia.org/wikipedia/commons/4/41/Isagogae_breves_in_anatomiam_humani_V00114_00000010.tif Public domain
Fig. 4
Fig. 4
Portrait of Andrea Vesalio (1514–1564) “De humani corporis fabrica 1543” (Wikipedia) https://images.app.goo.gl/eC7KdyKmsXJUDMsY9. Public domain
Fig. 5
Fig. 5
Anatomical drawing of the large bowel by Andrea Vesalio (The National Library of Medicine). Public domain
Fig. 6
Fig. 6
Portrait of Johannes Fernelius (1497–1558) c. 1550 (The National Library of Medicine) http://resource.nlm.nih.gov/101414339?_gl=1*4lacai*_ga*NjU2OTcxMjE2LjE3MTIwNDA4NTk.*_ga_7147EPK006*MTcxMjIyNjcwNS4xLjAuMTcxMjIyNjcwOC4wLjAuMA..*_ga_P1FPTH9PL4*MTcxMjIyNjcwNS4xLjAuMTcxMjIyNjcwOS4wLjAuMA. Public domain
Fig. 7
Fig. 7
Portrait of Giovanni Battista Morgagni (1682–1771) (University of Padua, Italy). Public domain
Fig. 8
Fig. 8
Anatomical drawing of the caecum by Giovanni Battista Morgagni from “De sedibus et causis morborum per anatomen indagati”, Nicolás León Library of the Department of History and Philosophy of Medicine, UNAM. Public domain
Fig. 9
Fig. 9
Portrait of Lorenz Heister (1683–1758) 1750 (Wikipedia) https://commons.wikimedia.org/wiki/File:Lorenz_Heister.jpg. Public domain
Fig. 10
Fig. 10
Portrait of Claudius Amyand (1680–1740), portrait by Thomas Gainsborough. Public domain
Fig. 11
Fig. 11
Drawing of the anatomical specimen with missing appendix by Jan van Rymsdyk (1767). Credit: Wellcome Library, London. Public domain
Fig. 12
Fig. 12
Painting by Gaspare Traversi “la visita medica”, 1752 (Gallerie dell’Accademia, Venezia, Italy). Public domain
Fig. 13
Fig. 13
Painting by Gaspare Traversi “l’intervento chirurgico” (Wikipedia) https://commons.wikimedia.org/wiki/File:1753_Traversi_Operation_anagoria.JPG. Public domain
Fig. 14
Fig. 14
Photo of Thomas Hodgkin (1798–1866) (Wellcome images) https://wellcomeimages.org/indexplus/image/L0008709.html. No changes were made
Fig. 15
Fig. 15
Photo of Robert Lawson Tait (1845–1899) (The National Library of Medicine) http://ihm.nlm.nih.gov/images/B24811. Public domain
Fig. 16
Fig. 16
Photo of Thomas George Morton (1835–1903) (University of Pennsylvania image gallery)
Fig. 17
Fig. 17
Photo of Charles McBurney (Wellcome images) https://wellcomeimages.org/indexplus/image/L0017167.html. No changes were made
Fig. 18
Fig. 18
MEYER KA et al. Progress in the treatment of acute appendicitis. Elsevier Licence Number: 5753080572666
Fig. 19
Fig. 19
Kurt Semm (1927–2003; Department of Obstetrics and Gynecology, University Clinic of Kiel) https://creativecommons.org/licenses/by-sa/3.0/de/deed.en
Fig. 20
Fig. 20
Roland E. Andersson (courtesy of the same author)
Fig. 21
Fig. 21
Paulina Salminen (University of Turku, Finland). https://ifso2024.org/project/paulina-salminen/ (last accessed 20.th October 2024)
Fig. 22
Fig. 22
Main steps in the knowledge of acute appendicitis and its treatment
See this image and copyright information in PMC

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