Diagnosis and Management of Acute Appendicitis

Acute appendicitis is one of the most frequent surgical emergencies worldwide, characterised by inflammation of the vermiform appendix. Prompt and accurate diagnosis is crucial to prevent progression to perforation, peritonitis or abscess formation, while minimising negative appendicectomy rates. Clinical assessment remains the foundation, combining patient history with physical examination and laboratory markers such as white cell count and C-reactive protein. Clinical decision rules, notably the Alvarado score, stratify patients by likelihood of appendicitis and guide further investigation. Imaging modalities—ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI)—have become increasingly prevalent, improving diagnostic accuracy especially in atypical presentations. Uncomplicated appendicitis, confined to mucosal and submucosal layers, may be managed non-operatively with antibiotics in selected patients, while complicated appendicitis with perforation, phlegmon or abscess generally requires surgical intervention. Laparoscopic appendectomy has emerged as the gold standard surgical approach, offering reduced postoperative pain, shorter hospital stays and faster return to normal activity compared with open surgery. In cases of periappendiceal abscess, percutaneous drainage coupled with interval appendectomy represents an effective strategy. Recent advances include refined risk-stratification algorithms, tailored antibiotic regimens and evaluation of the gut and oral microbiome’s role in disease severity. Global variations in incidence and outcomes underscore the need for context-sensitive protocols and equitable access to diagnostic and therapeutic resources.

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Diagnosis and Management of Acute Appendicitis publication trend

The graph below shows the total number of articles in diagnosis and management of acute appendicitis across all publications each year (not limited to Nature Index journals).

Technical terms

Complicated appendicitis: Inflammation of the appendix with perforation, abscess or phlegmon formation.

Uncomplicated appendicitis: Inflammation confined to the appendix without perforation or abscess.

Alvarado score: A clinical scoring system combining symptoms, signs and laboratory results to estimate appendicitis probability.

Computed tomography (CT): Cross-sectional imaging modality that enhances diagnostic accuracy in equivocal cases.

Laparoscopic appendectomy: Minimally invasive surgical removal of the appendix using small abdominal incisions and a camera.

References

1. Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. The Lancet Gastroenterology & Hepatology (2024).
2. Acute appendicitis manifests as two microbiome state types with oral pathogens influencing severity. Gut Microbes (2023).
3. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery (2020).
4. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. The BMJ (2012).
5. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine (2011).
6. Laparoscopic versus conventional appendectomy - a meta-analysis of randomized controlled trials. BMC Gastroenterology (2010).
7. Diagnosing Appendicitis: Evidence-Based Review of the Diagnostic Approach in 2014. Western Journal of Emergency Medicine (2014).