- Inflammation of the appendix that lead to infection (abscess) and/or perforation if not recognized and treated appropriately
**Most common abdominal surgical emergency**
- Most common in ages between 10 – 30
- lymphoid hyperplasia,
- fecalith obstruction (hardening of feces into lumps of varying size inside)
- Perforation occurs in about 20%
- Initial symptom is intermittent periumbilical or epigastric pain.
- Then localizes to the RLQ (McBurney’s point) and becomes constant
- Pain is worsened by movement
- Nausea and anorexia
- Low-grade fever
Specific localization of tenderness to McBurney’s point indicates that inflammation is no longer limited to the lumen of the bowel (which localizes pain poorly), and is irritating the lining of the peritoneum at the place where the peritoneum comes into contact with the appendix.
Location of McBurney’s point (1), located two thirds the distance from the umbilicus (2) to the anterior superior iliac spine (3).
PHYSICAL EXAM FINDINGS
- Abdominal rebound tenderness and guarding
- Positive Psoas sign (pain with raising a straight leg with resistance)
- Positive Obturator’s sign (pain with flexed right hip rotation)
- Sometimes pt may have RLQ pain on palpation of LLQ
Pain is elicited by performing the psoas test by passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip. If abdominal pain results, it is a “positive psoas sign“.
The pain results because the psoas borders the peritoneal cavity, so stretching (by hyperextension at the hip) or contraction (by flexion of the hip) of the muscles causes friction against nearby inflamed tissues. In particular, the right iliopsoas muscle lies under the appendix when the patient is supine, so a positive psoas sign on the right may suggest appendicitis. A positive psoas sign may also be present in a patient with a psoas abscess
Obturator’s sign: If an inflamed appendix is in contact with the obturator internus, spasm of the muscle can be demonstrated by flexing and internal rotation of the hip. This maneuver will cause pain in the vagina hypogastrium.
- Gynecologic Disorders
- Ectopic pregnancy
- Kidney stones
- Mechanical obstruction
CT is choice diagnostic test***
- Microscopic hematuria and pyuria may be seen
- Radiographic finding of free air suggests perforation
- Appendectomy: laparoscopic – longer surgery time than open surgery, shorter recovery time, and less infectious complication
- Antibiotics may be indicated prior to surgery