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New Treatments for Appendicitis

About 10% of the population will develop acute appendicitis during their lifetime. Appendicitis is most common in the teens and twenties. Appendicitis is caused by appendiceal obstruction, mucosal ischemia, infection, and perforation. Escherichia coli occurs in 80%, Bacteroides fragilis in 70%, and Pseudomonas spp in 40%.

Clinical presentation. Appendicitis typically begins with progressive midabdominal discomfort which is unrelieved by the passage of stool or flatus. Ninety percent of patients are anorexic, 70% have nausea and vomiting, and 10% have diarrhea. The pain becomes localized to the right lower quadrant after 4-6 hours when the inflammation extends to the parietal peritoneum. Peritoneal irritation is associated with pain on movement, mild fever, and tachycardia.

Abdominal palpation should begin at a point abdominal pain, abscess distal to the right lower quadrant.

Pain in the right lower quadrant during palpation of the left lower quadrant (Rovsing's sign) indicates peritoneal irritation. The degree of direct tenderness and rebound tenderness should be assessed. The degree of muscular resistance to palpation reflects the severity of inflammation. Cutaneous hyperesthesia often overlies the region.

Leukocyte count greater than 11,000 cells/ul with polymorphonuclear cell predominance is common in children and young adults.

Urinalysis is abnormal in 25% of patients . Pyuria, albuminuria, and hematuria are common. Large numbers of bacteria abdominal pain suggest urinary tract infection. Significant hematuria suggests urolithiasis.

Serum pregnancy test should be performed in women of childbearing age. A positive test suggests an ectopic pregnancy.

Abdominal x-rays. An appendicolith can be seen in only one-third of children and one-fifth of adults. The combination of localizing abdominal pain and an appendicolith is 90% sensitive. The can indent the cecum, and tissue edema can cause loss of peritoneal fat planes around the psoas muscle and kidney.

Ultrasonography. Findings associated with appendicitis include wall thickening, luminal distention, lack of compressibility, abscess formation, and free intraperitoneal fluid.

Surgical Treatment