THE APPENDIX

FISIOANATOMICCONSIDERATIONS

EMBRYOLOGY

The cecal appendix is derived from the midgut along with the small intestine, the cecum, the ascending colon, and the middle.
right of the transverse colon; all these structures in turn supplied by the superior mesenteric artery.

It is visible in the eighth week of gestation and the first accumulations of lymphoid tissue develop during the
weeks fourteen and fifteen of gestation. As the appendix developed during the descent of the colon, it often ends up
situated behind the blind or the colon. These positions are called retrocecal or retrocolic, respectively.

Anomalías congénitas: Ausencia de apéndice, apéndice ectópico, apéndice izquierdo, duplicación de apéndice

ANATOMY

DESCRIPTION:
The cecal appendix is a true diverticulum of the cecum; in adults, the average length of the appendix
is 6 to 9 cm; however, it can have a variable length ranging from < 1 to > 20 cm. The diameter
The external diameter varies between 3 and 8 mm, while the luminal diameter varies between 1 and 3 mm.
Its anatomical disposition is variable, which plays an important role in the symptomatic difference in
case of acute appendicitis: retrocecal, pelvic, paracecal, subcecal, postileal and preileal.
IRRIGATION:
The appendix receives its arterial supply from the appendicular branch of the appendicular artery, branch
terminal of the ileocecal from the right colic artery.

INNERVATION
The innervation of the appendix derives from sympathetic elements supplied by the mesenteric plexus.
superior (T10-L1) and afferent fibers of the parasympathetic elements through the vagus nerves

LYMPHATICDRAINAGE:
The lymphatic drainage of the appendix flows to the lymph nodes located along the artery.
ileocolic.

HISTOLOGY

The histological characteristics of the appendix are contained in the following three.
caps:

The external serosa, which is an extension of the peritoneum.

The muscular layer, which is not well defined and does not exist in some places.
The submucosa
The mucosa.

It is made up of simple cylindrical intestinal epithelium with a thin striated border and few
goblet cells that line its mucosa and lack villi.

Lymphoid nodules exist in the submucosa of the appendix and can extend to the
muscular of the mucosa; the crypts are irregularly distributed, they are of
different sizes and below the crypts are cell complexes
neuroendocrine composed of neurosecretory cells, ganglion cells, cells
from Schwann and neural fibers.

PHYSIOLOGY

For many years, the appendix was mistakenly considered a vestigial organ without a function.
recognized. It is now well recognized that the appendix is an immune organ that actively participates in secretion
of immunoglobulins, especially immunoglobulin A.
 ACUTEAPPENDICITIS

INTRODUCTION

Acute appendicitis is the main cause of acute surgical abdomen. In cases of appendicitis, it is important
consult a doctor as soon as possible in the presence of the characteristic symptoms of the disease, that is why
it is important to have a thorough understanding of its anatomy, pathophysiology, and evolution in order to make the diagnosis and
provide timely treatment that prevents later complications.

BACKGROUND

The human appendix was not identified until the year 1492; Leonardo da Vinci drew the appendix in his drawings.
anatomical, but these were not published until the eighteenth century.

In 1521, Berengario Da Capri and in 1543, Andreas Vesalius published drawings that recognized the appendix.

Jean Fernel is credited as the first to describe appendicitis in a study published in 1544.

In 1711, Lorenz Heister made the first description of characteristic appendicitis.

The first known appendectomy was performed in 1736 by Claudius Amyand in London.

In 1886, Reginald H. Fitz presented his findings regarding appendicitis and recommended considering the
surgical treatment.

DEFINITION

It is the acute inflammation of the cecal or vermiform appendix, which begins with obstruction of the appendicular lumen, leading to
as a consequence an increase in intraluminal pressure due to the accumulation of mucus associated with low elasticity of the
serosa.

INCIDENCEANDEPIDEMIOLOGY

Acute appendicitis is the most common cause of emergency surgery today, with a rate of almost
100 cases per 100,000 person-years in Europe while in the American continent it is almost 11 cases.
per 10,000 person-years
Appendicitis occurs more often in westernized societies.
The risk of developing appendicitis during life is 8.6% for males and 6.7% for females.
women, with the highest frequency in the second and third decades of life. It is relatively rare in
extreme age groups, although more complicated.
The mortality in uncomplicated cases is very low, significantly increasing in the case of perforation,
which is more common in the elderly and infants.

PATHOPHYSIOLOGY

ETIOLOGY
It is believed that appendicitis is due to the obstruction of the appendiceal lumen, generally caused by lymphoid hyperplasia, but,
sometimes, due to a fecalith, a foreign body, or even helminths.

Fecaliths and stones are identified in 40% of cases of simple acute appendicitis, in 65% of cases of appendicitis.
gangrenous without perforation and in almost 90% of cases of gangrenous appendicitis with perforation.

PATHOGENESIS
The obstruction of the appendicular lumen causes accumulation of mucus and bacteria, venous congestion, tissue ischemia, and with
posterior excessive bacterial growth, suppuration, and subsequently perforation with abscess formation
located generalized peritonitis.

Microbiology

The bacterial flora found in the cecal appendix is similar to that of the rest of the colon, although this flora depends
from various factors such as: age, diet, hygienic and cultural conditions, and above all, the use of
antibiotics.

Appendicitis is an infection, polymicrobial, among which aerobic microorganisms can be found.

anaerobes, but the most common microorganisms found in the cultures are: Escherichia coli, Pseudomonas
aeruginosa, Klebsiella spp., Bacteroides fragilis, and Streptococcus faecalis.

STAGESOFACUTEAPPENDICITIS

Based on histological findings and macroscopic appearance, several stages or phases can be differentiated.
in appendicitis. The classification of appendicitis depending on its evolution is as follows:

GRAD NAME CHARACTERISTIC IMAGE

O
It occurs due to the obstruction of the lumen.
appendicular that leads to accumulation
of mucus secretion and increase in the
intraluminal pressure due to deficiency of
elasticity of the appendicular serosa. It
it forms an ideal medium for the start of the
APPENDICITIS bacterial growth. Obstruction appears
CONGESTIVE, of lymphatic drainage with appendicular edema and
1
CATARRHAL OR mucosal ulcerations.
MUCOSA
At the histopathological level, there is a
inflammatory reaction that leads to the
serosa to have a normal shiny appearance to
an opaque, granular, and reddish membrane
Mucopurulent secretion continues,
bacterial growth and appendicular edema
producing an increase in pressure
intraluminal and tissue, obstruction of flow
venous and arterial, and bacterial invasion towards
the appendicular wall up to the serosa with
formation of the inflammatory liquid that irritates the
parietal peritoneum.
APPENDICITIS At the histopathological level, the progression
 2 FLEMONOSA continue until producing an exudate
O prominent neutrophilic characterized
SUPPURATIVE to infiltrate the own musculature, the
What is considered a histological criterion?
although it can also be found in the
mucous membrane); next, it occurs
a fibrinopurulent reaction on the serosa
forming an abscess in the wall as it progresses
natural evolution of acute appendicitis.

Venous and arterial thrombosis occurs.

that forms areas of small infarcts in the
appendicular skeleton and micro development
drillings with escape of bacteria and
invasion of the peritoneal cavity.
3 APPENDICITIS At the histopathological level, large
GANGRENOUS areas of green hemorrhagic ulceration in
AO the mucosa and concomitant necrosis
NECROTIC dark green gangrenous in the
wall extending to the serosa

Presence of gangrenous infarction of the wall

4 APPENDICITIS appendicular with drillings
macroscopic features of the anti-mesenteric border.
PERFORATED
Pus material is produced.
frank to the peritoneal cavity

CLINICALPICTURE

SIGNSANDSYMPTOMS
The classic clinical picture of appendicitis begins with the main symptom which is:

Colicky pain, of visceral nature, localized in the periumbilical region or in the epigastrium, with increase
intense rapid, migrates to the right iliac fossa (RIF) within 24 hours due to contact with the inflamed serosa
with the parietal peritoneum and turns into somatic pain. The pain increases when walking and coughing.

After the onset of pain, there may be:

Nausea and vomiting not very numerous (generally on 2 occasions).

Anorexia
Fever of 38°C or higher can occur inconsistently in up to 40% of cases.

Less common:

Chills
Loss of appetite
Diarrhea (pediatric patients) or constipation
Peristalsis

Patients who have symptoms for more than 48 hours are at greater risk of perforation.

Cases with perforation are accompanied by:

Alteration of vital signs
Tachycardia
Hyperthermia
Oliguria
Signs of dehydration
Abdominal tenderness upon palpation more intense with abdominal resistance and the typical signs of irritation.
peritoneal

APPENDICULARSIGNS:
McBurney's sign: localized abdominal resistance in the right iliac fossa
Morris Point: Painful point at the junction of the middle third with the inner third of the umbilical-spinal line.
right. It is associated with the retroileal location of the appendix.
Launch Point: Painful point at the convergence of the interspinal line with the outer edge of the muscle
right anterior rectum. It is associated with the location of the appendix in the pelvic cavity.
Lecene Point: Painful point approximately two centimeters above and outside the iliac spine.
anterosuperior. It is associated with the retrocecal location of the appendix.
Summer sign: Involuntary defense of the abdominal wall muscles over an area of inflammation
intraperitoneal. It is more objective than pain on pressure and occurs in 90% of cases.
Von Blumberg sign: Pain in the right iliac fossa upon decompression. It occurs in 80% of cases.
Mussy sign: Pain upon palpation in any part of the abdomen. It is a late sign of appendicitis.
since it is currently considered a phase IV appendicitis
Aaron's sign: Consists of pain in the epigastric region or precordial area when the right iliac fossa is palpated.
Rovsing's sign: Pain in the right iliac fossa upon compressing the left iliac fossa is explained by the
displacement of the gases by the explorer's hand of the descending color towards the transverse colon
ascending and blind, which expands and moves, causing pain in the inflamed appendix.
Chase sign: Pain in the right iliac fossa when pressing on the transverse colon region.
Explanation is the same as the previous sign.
Psoas Sign: Gently place the hand on the right iliac fossa until a mild pain is provoked and then...
stretch until the pain disappears, without pulling it away, the patient is asked to lift it without bending the knee
right lower limb; the psoas muscle brings its insertions closer and broadens its muscular part by mobilizing
 the blind man and projecting it against the hand that is resting on the abdomen, causing pain, It is
suggestive of a retrocecal appendix.
Shutter sign: The hip is flexed and the knee is positioned at a right angle, performing an internal rotation.
from the lower limb, which causes pain in the case of an appendix located in the pelvic area.
Dieulafoy’s appendicular triad: It consists of skin hypersensitivity, abdominal pain, and muscle contraction in
right iliac fossa.
Klein's maneuver: With the patient in the supine position, the most painful abdominal point is marked, then it is changed.
Position the patient in the left lateral decubitus and press the painful point again. For appendicitis.
the painful point remains the same and the patient flexes the right pelvic limb, to
the painful spot changes.
Alders Maneuver: The same maneuver as before, only it differentiates uterine pain from appendicular pain.
Haussmann maneuver: The McBurney point is pressed, the extended lower limb is raised until
that it forms an angle of about 60° with the bed plane; the pain increases in appendicitis.
Talopercussion sign: Pain in the right iliac fossa with the patient in supine position when slightly raising the
right pelvic member and lightly hit the heel.
Britar sign: Right testicular elevation upon pressure in the right iliac fossa.
Llambias sign: When the patient is jostled, the pain increases in the right iliac fossa.
Sign of San Martino and Yodice: The relaxation of the anal sphincter allows the reflex pains to disappear and
that only the truly painful point remains.
Chutro Sign: Due to muscle contraction, there is a deviation of the navel towards the right iliac fossa.
Copoe sign: Sensitivity in the appendix when stretching the psoas muscle by extending the lower limb.
Horn sign: Pain occurs in the right iliac fossa due to traction of the right spermatic cord.
Rover's sign: Appendicular pain is preceded by pain in the epigastrium.

The anatomical variants of the appendix can alter the usual signs and symptoms of the condition and can
the pain presents more laterally or localized in an upper abdominal section.

DIAGNOSIS

A well-developed medical history, as well as a good physical examination, provide the diagnosis in most cases.
cases.

The diagnosis of acute appendicitis is clinical in 80% of cases when the patient presents 2 or more signs or symptoms of
the following: vomiting, pain in the right lower quadrant, tenderness on palpation or abdominal guarding.

It should be taken into account that in patients presenting atypical symptoms such as children under 2 years old, elderly adults
From 60 years old, patients with anatomical variations and pregnant women, a late diagnosis is made for this reason.

Acute appendicitis is the most common non-obstetric surgical condition during pregnancy. It is estimated to occur in 1 per
every 1,500 pregnancies, although there are reports that refer to up to 1 in every 6,600 which represents 0.05% to 0.07%. It is
more frequent in the second trimester.

The morbidity and mortality rate increases considerably; in the case of pregnant women, it should be taken into account.
the physiological changes themselves, such as nausea, vomiting, hyporexia, leukocytosis, and the increase in uterine size
proportional that leads to the displacement of intra-abdominal organs

AUXILIARYEXAMS

LABORATORY
It relies on the presence of leukocytosis with neutrophilia and bandemia, although their presence is not imperative, especially
in the early hours of evolution; likewise, the presence of leukocytosis > 18,000 mm3 is indicative of perforation;
The elevations of C-reactive protein and procalcitonin suggest the presence of perforation and abscess.

The general urine test can be useful to rule out urinary tract infection; however, there may be several
leukocytes or erythrocytes due to irritation of the ureter or bladder. In general, bacteriuria is not observed.
 IMAGE
Simple abdominal x-rays can reveal direct or indirect signs, such as the presence of a fecalith.
radiographic findings, distension of loops of small intestine in the right iliac fossa, blurring of the right psoas, scoliosis
analgesic, blind fixed when comparing positions in lying down and standing, and in complicated cases it can present
image in frosted glass or generalized ileus.

Computed tomography of the abdomen is a reliable diagnostic tool with an accuracy close to
95%; their criteria are particularly the appendicular diameter (> 6 mm), the wall thickness (> 2 mm), the inflammation
periapendicular, the presence of fecaliths and occasionally the arrowhead sign (cecal thickening that makes
contrast with the appendicular opening.

Abdominal ultrasound is not as accurate as tomography and is operator-dependent, but in patients

Pregnant women and children may be useful; likewise, nuclear magnetic resonance and tomography are useful.
with greater sensitivity and specificity.
 CLINICALRATING SYSTEMS
The Alvarado scale is one of the most frequently used classifications and is predominantly based on
the symptoms:

All parameters represent a point, except for the presence of rebound and leukocytosis, which are rated with two;
the presence of seven or more points is very suggestive of acute appendicitis. It is particularly useful for recognizing the
patients who should be the subject of further study.

DIFFERENTIALDIAGNOSIS
The differential diagnosis of acute appendicitis depends on four main factors: the anatomical location of
inflamed appendix; the stage of the process (uncomplicated or complicated); the age and gender of the patient

The differential diagnosis of acute appendicitis is basically the diagnosis of acute abdomen. A clinical picture
identical may be due to a wide range of acute processes in the peritoneal cavity that produce the same
physiological alterations that acute appendicitis.

The differential diagnosis is established with:

Pediatric patients: mesenteric adenitis and acute gastroenteritis

Female patients: pelvic inflammatory disease, rupture of Graafian follicle, urinary infection,
endometriosis, ruptured or imminent ectopic pregnancy, twisted ovarian cysts, ovarian tumor, and hemorrhage
intraperitoneal secondary to ovulation
Elderly patients: perforated cecal cancer, right diverticulitis, acute crisis of fever from
Mediterranean, infarcted epiploic appendage, right ureteral lithiasis, ileocecal Crohn's disease, diverticulum
de Meckel, appendicular tumors, appendicular mucocele, pseudomyxoma peritonei, and appendicular neuroma.
 TREATMENT

Once the diagnosis is established, it is necessary to stabilize the patient as appropriate, start the administration of
parenteral solutions to control dehydration and hydroelectrolytic imbalance, and to institute treatment
antimicrobial and analgesics to improve the general conditions of the patient.

The definitive treatment of acute appendicitis is surgical, either by open or laparoscopic approach; once established
the diagnosis, and while the patient awaits their turn in the operating room, it is advisable to administer antibiotics of
broad spectrum that covers enterobacteria and anaerobes

PRE-SURGICALANALGESICS:
Several studies mention that the use of analgesics prior to the diagnosis of appendicitis is contraindicated due to
risk of masking the symptomatology and not diagnosing a surgical condition in time, thereby affecting this
patients' prognosis.

There are studies that show that opioid analgesics would not affect diagnostic accuracy as none was found.
significant difference regarding their clinical and laboratory characteristics; this could be due to their inhibition of the
gastrointestinal propulsive activity as it preserves the extrinsic innervation of the intestine intact; not so with the use
of NSAIDs, since their anti-inflammatory effect in the peritoneum affects diagnostic precision in a second
evaluation.

The dosages of opioids vary with each author of these studies, but the commonly administered dose in
patients with acute abdominal pain are:

Morphine 0.1 mg/kg IV with a maximum dose of 10 mg over a period of 5 minutes

Tramadol 1 mg/Kg,
Codeine 0.5 mg/kg or papaveretum 20 mg

ANTIBIOTICPROPHYLAXIS:
Depending on the presentation of acute appendicitis and the type of surgery the patient undergoes, whether it is surgery
clean-contaminated, contaminated or dirty, depending on the degree of evolution of acute appendicitis, it is necessary to implement
perioperative prophylactic schemes in order to prevent infections in the post-surgical stage

Due to the bacteriology present in the appendix, prophylactic schemes have been established, among which are:

Ceftriaxone 1-2 g IV + Metronidazole 500 mg IV,

Cefazolin 1-2 g IV
Ampicillin - Sulbactam 3 g IV

The application of antibiotic prophylaxis has been shown to decrease the occurrence of postoperative complications.
infectious types, the length of hospital stay and costs; as long as it is administered properly

In cases of perforated acute appendicitis, the use of prophylactic antibiotics is started 30 minutes before the intervention.
reducing postoperative complications, mostly surgical wound infection and abscess formation
intraabdominal. The collection of peritoneal fluid culture has not shown effectiveness in treatment, however, its
its use remains in effect in many institutions. The initial handling of these cases must include:

Immediate cessation of the oral route.

Initial intravenous resuscitation with fluids for hydration such as 0.9% Saline Solution or Ringer's Lactate.
Start antibiotic dosing with cefazolin or ampicillin + sulbactam.
Emergency surgical intervention.

SURGICALMANAGEMENT
There are essentially two types of interventions. In recent years, laparoscopic technique has supplanted open technique.
in high specialty centers because it offers less morbidity in complicated and uncomplicated appendicitis.
However, among authors, open surgery is still practiced more frequently due to the limited
requirement for specialized materials and equipment and the lower costs.

There are no significant differences between the open and laparoscopic approaches in general, although there are
certain subgroups of patients such as obese individuals, women of childbearing age or those with diagnostic doubts, who do
benefician de un abordaje laparoscópico. Además, si existen signos de peritonitis aguda difusa, el abordaje laparoscópico
allows for a better wash of the entire abdominal cavity (difficult from the usual McBurney incision)

OPENAPPENDICECTOMY
1. It is generally performed with the patient under general anesthesia; the patient is placed in a supine position.
The abdomen is prepared, and drapes are placed to cover everything in case it is necessary to make an additional incision.
big.
In the early stages of non-perforated appendicitis, an incision in the lower right quadrant is often used.
at McBurney's point (one third of the distance from the anterior superior iliac spine to the navel).
make a McBurney incision (oblique) or a Rocky-Davis incision (transverse) that separates the muscles of the quadrant
right lower quadrant. If perforated appendicitis is suspected or there are doubts about the diagnosis, it is considered
laparotomy in the lower portion of the midline.

4. After entering the abdominal cavity, the patient should be placed in a slight Trendelenburg position with
rotation of the bed to the left of the patient. If the appendix is not easily identified, the cecum is located.
Following the taeniae (the previous taeniae), the most visible of the three taeniae of the colon, towards the distal portion, is
can identify the base of the appendix.
[Link] the appendix is located, it is exposed in the wound and removed if possible along with part of the cecum;
6. Clamping and ligation are systematically performed before cutting until reaching the appendicular artery.
and the cecal base
7. Next, the ligation of the appendicular stump is performed with absorbable material; this can be just
ligated (Pouchet technique) or invaginated in the cecum with a purse-string suture (Halsted technique) in
very broad base cases, an invagination can be created with several points in the cecum (Parker technique
Kerr).

8. The closure must be performed using absorbable material and the skin is closed systematically, although in
In cases of perforation, the risk of wall abscess is approximately 5%.
 LAPAROSCOPY
The first surgeon to perform this approach was Kurt Semm in 1983.

1. The procedure always requires the use of general anesthesia; the recommended position is that of
Trendelenburg with slight left lateralization; the surgeon and the assistant are positioned on the left side of the
patient

2. When performing laparoscopic appendectomy with a single incision, the surgeon's hands perform the function
opposite that I would normally perform in the standard laparoscopic operation.
3. With his right hand, the surgeon holds the appendix and moves it to the lower right quadrant in the
position of the clock hands at 10 o'clock
4. With the left hand, the dissection of a mesenteric opening is performed until the base is clearly identified.
the staple is applied through the base of the appendix and the mesentery
5. The appendix can be placed in a recovery bag or removed through the individual incision.
 OPEN VS LAPAROSCOPICAPPENDECTOMY
Open appendectomy remains the most common emergency surgery in emergency services.
Open surgery has shown low rates of morbidity and mortality, which is why it continues to be considered the preferred approach.
Although it is considered the surgical technique of choice, it is associated with postoperative pain and delays in recovery.
of physical and work activities.

Laparoscopic appendectomy is associated with fewer infections at the surgical wound incision.
comparison with open appendectomy; however, it may be accompanied by a higher risk of abscess
intra-abdominal compared to the open technique. There is less pain, hospitalization is shorter, and resumption
normal activities are resumed more quickly after laparoscopic appendectomy than after an appendectomy.
open

The prevalence of postoperative complications is higher in open surgery at 17.1%, while in

laparoscopic intervention, remains at 12%.

Due to the information acquired and despite the fact that many authors mention their arguments for or against the
Surgical techniques, both conventional and laparoscopic techniques, are effective for the management of the condition.
acute abdominal pain of appendiceal origin.

POSTOPERATIVECARE

COMPLICATED APPENDICITIS UNCOMPLICATED APPENDICITIS

Cefoxitin 2 g every 6 hours or every 8 hours for 5 Days
days or until the patient is
ANTIBIOTICS It is not necessary
afebrile for 24 hours and that their
analytical parameters are found
in the normality.
NASOGASTRIC TUBE Necessary Not necessary
ORAL INGESTION Maintain fluid therapy Oral ingestion begins on the 2nd day of
postoperative
 HOSPITAL DISCHARGE The patients require ICU On the second or third day

COMPLICATIONS

Despite being a simple procedure, complications are not uncommon, affecting 20% of patients.
Post-appendectomy patients suffer from it, and although there has been improvement in the techniques and technology for the procedure.
There is always the risk of their occurrence, many of which are correlated to the response of the
patient before surgery.

EVOLUTIONARYCOMPLICATIONS
Perforation. Characterized by more intense pain and fever above 38 °C. Urgent surgery is required.
Appendiceal abscess. When the perforation is localized by adhesions of the omentum, an abscess forms.
localized periapical that must be drained.
Peritonitis. If the contamination spreads, it diffuses by gravity towards the Douglas pouch or by the
Right colic gutter, causing diffuse peritonitis. Increases abdominal hypersensitivity and rigidity.
along with adynamic ileus and high fever.
Pylephlebitis. It is the suppurative thrombophlebitis of the portal venous system generally caused by E. coli, in processes that
drainage through a portal (typically in perforated or gangrenous appendicitis and diverticulitis). It may appear
preoperatively or postoperatively. It is accompanied by fever, chills, mild jaundice and, subsequently,
liver abscesses. CT is the best method to detect thrombosis and gas in the portal vein. Precise
urgent surgery to control the septic focus.
Appendicular plastron. The untreated inflammatory process produces a plastron (palpable mass). It is diagnosed.
through You. Conservative treatment with intravenous antibiotics and drainage of collections must be established,
unless the patient's condition worsens. If they continue to experience discomfort in the area, after a period of monitoring, they
elective surgery (delayed or interval appendectomy) is recommended 10-12 weeks after the episode.
sharp.

POSTOPERATIVECOMPLICATIONS
Wound infection. It is the most common complication. It occurs 4-7 days after the intervention. It is characterized by the
appearance of pain and local signs, heat, suppuration, erythema ... The treatment is the opening of the wound and washing,
letting it close for the second intention.

Intra-abdominal abscesses. Generally after perforated appendicitis. They manifest as fever with a needle-like pattern.
from the 6th to the 10th postoperative day. It is diagnosed with CT and the treatment generally consists of radiological drainage.
percutaneous and intravenous antibiotics.

Paralytic ileus. It is primarily caused by perforated appendicitis. It is treated conservatively.

Appendicitis of the appendiceal stump is a rare complication; fewer than 50 cases have been reported.
medical publications; it can occur when a stump greater than 5 mm is left and is generally identified in
cases already perforated due to a delay in diagnosis because it is unlikely to think of the recurrence of the
appendicular process; most of the time open surgery and colectomy are needed.

Other less common complications are

Intestinal obstruction due to adhesions

Cecal fistula due to appendiceal stump opening
Hemorrhage
Retroperitoneal hematoma
Hernia
Evisceration
 FORECAST

Most patients with appendicitis recover easily after surgical treatment, however,
Complications may occur if the treatment is delayed.

Recovery depends on the age and health condition of the patient.

Generally, recovery after an appendectomy takes between 10 and 28 days, and in children up to 10 years old,
it can take up to 3 weeks

Mortalityrate
In general, the prognosis is favorable in uncomplicated cases and in advanced ones, good management judgment.
makes mortality extremely low.

The mortality from acute appendicitis is very low (0.26 per 100,000) and is mainly associated with the presence of
drilling, comorbidities and presentation at the ends of life

In uncomplicated appendicitis, it is 0 - 0.3%.

In complicated appendicitis, it is 2%.
The mortality rate in perforated appendicitis in infants and the elderly is 10-15%.