Acute inflammation of the vermiform appendix, classically progressing to perforation if untreated.
Clinical features
- • Periumbilical pain migrating to RIF
- • Anorexia, nausea, vomiting
- • Low-grade fever
Examination
- • RIF tenderness at McBurney's point
- • Rovsing, psoas, obturator signs
- • Rebound, guarding if peritonitic
Investigations
- • FBC (↑WCC), CRP
- • Urine βHCG (women)
- • US (children, women)
- • CT abdo (adults, equivocal)
Diagnosis
- • Alvarado score ≥7
- • Imaging confirms in equivocal cases
Differential diagnosis
- • Mesenteric adenitis
- • Ovarian cyst, ectopic, PID
- • Meckel diverticulitis
- • Crohn ileitis
- • UTI
Management
- • IV fluids, analgesia, antiemetics
- • Laparoscopic appendicectomy
- • Antibiotics-only in selected uncomplicated cases
Drug therapy
- • Co-amoxiclav 1.2 g IV q8h pre-op
- • Metronidazole 500 mg IV q8h if perforated
Complications
- • Perforation, abscess
- • Generalised peritonitis
- • Wound infection, ileus
Clinical pearls
- • Pregnant women: appendix displaced upward → RUQ pain
- • Negative appendicectomy rate <10% acceptable
Related in WardRound
Educational — verify locally.
