Appendicitis
• 7% lifetime risk of developing appendicitis.
• Peak at 10 and 30 years of age, but may occur in men and women of any age.
• Signs and Symptoms?
• Physical Exam?
Signs
• Dunphy sign: increased pain with any coughing or movement
• Rovsing sign: is RLQ pain that is induced by palpation of the left lower quadrant and is highly suggestive of a RLQ inflammatory process.
• The obturator sign: is seen with inflammation of a pelvic appendix and refers to pain on internal rotation of the right hip.
• The iliopsoas sign: is most often seen with a retrocecalappendix and refers to pain on extension of the right hip.
• Aure-Rozanova sign, Bartomier-Michelson's sign, Kocher's (Kosher's) sign, Massouh sign, and Sitkovskiy (Rosenstein)'s sign.
CT scan
• Enlarged appendix >6 mm in diameter• Appendiceal wall thickness >2 mm• Periappendiceal inflammation (fat stranding)• The presence of a fecalith• Wall enhancment• The presence of the arrowhead sign (thickened
cecum funneling contrast toward the appendicealorifice)– The risk of radiation-induced malignancy has been
recently estimated at 0.18% following exposure to abdominal CT.
DDx
• inflammatory bowel disease• Crohn's ileitis • Gynecologic pathology (mittelschmerz, salpingitis, ectopic pregnancy,
tubo-ovarian abscess, and endometriosis ). • gastroenteritis. • diverticulitis• Meckel's diverticulitis • Renal Colic• acute mesenteric adenitis. • epiploic appendagitis, torsion, and thrombosis of a pedunculated adipose
structure off the serosal surface of the cecum may resemble appendicitis but can be distinguished on CT scan.
• familial Mediterranean fever (FMF).• Yersenia infection• TB
Open Vs. Lap
– Laparoscopic appendectomy leads to a shortened hospital stay for patients with uncomplicated acute appendicitis, less postoperative pain, faster return to work, and lower total cost of care.
– Laparoscopic appendectomy was associated with a lower incidence of postoperative wound infection than open appendectomy was (3.5% versus 6.7%), but it was also associated with a higher incidence of postoperative intra-abdominal abscess (2.5% versus 1.1%). The length of stay was slightly shorter after laparoscopic appendectomy (1 to 4.9 days; average 2.7 days) than after open appendectomy (1.2 to 5.3 days; average 3.2 days)
• At present, however, the only patients for whom laparoscopic appendectomy appears to offer significant advantages are
– women of childbearing age
– Obese patients
– Patients with an unclear diagnosis.