Appendicitis, Acute

One of most common abdominal emergencies

Possible at any age but most common during an individual’s teens and 20s

11 in 10,000 individuals will experience appendicitis

M:F ratio 1.4:1

Most common reason for nonobstetric surgery during pregnancy; Occurs in 1 out of every 800 to 1500 pregnancies; slightly more common during second trimester; incidence of perforation highest during third trimester (70%)

Risk of intraabdominal perforation or abscess; risk increases with delay in diagnosis and treatment.

Ileus.

Sepsis.

Fecal fistula.

Mortality is 2-3% for perforated versus 0.1% for nonperforated appendicitis.

Mortality for perforated appendicitis higher in elderly and pregnant pts.

In pregnant pts, fetal mortality of approximately 35% for perforated appendicitis compared with 1.5-3% for uncomplicated appendicitis.

Airway and aspiration risk because pt may have full stomach with symptomatic nausea and vomiting

Tachycardia due to pain, dehydration, or sepsis

Hypotension due to dehydration or sepsis (poor PO intake, vomiting, diarrhea, or intra-abdominal abscess)

Preop IV antibiotics

Appendicitis in pregnancy

• Possible delay in diagnosis due to atypical symptoms, as well as hesitation in performing imaging and diagnostic studies out of concern for the fetus

• Awareness of anatomic and physiologic changes of the parturient

• Avoidance of teratogenic agents and risk factors for intrauterine fetal asphyxia

One of the most common abdominal emergencies in children, adults, and pregnant women.

Increased risk of perforation if diagnosis delayed over 24 h.

Increased morbidity/mortality with perforation.

Pts may present with right-lower-quadrant or diffuse abdominal pain, nausea and vomiting, diarrhea, anorexia, malaise, fever, or mild leukocytosis.

Primarily due to appendiceal obstruction (80%); obstruction most commonly due to fecaliths, hyperplasia of lymphoid follicles (commonly in pediatric pts), stones, or tumors.

Obstruction of the appendix causes increased intraluminal pressure, which leads to thrombosis and occlusion of blood vessels and lymphatics supplying it: this causes organ inflammation and ischemia, which can further progress to perforation, intraabdominal abscess, and peritonitis.

Appendiceal inflammation leads to bacterial proliferation, most commonly anaerobic and gram-negative organisms.