TY - JOUR
T1 - Acute appendicitis
T2 - modern understanding of pathogenesis, diagnosis, and management
AU - Bhangu, Aneel
AU - Søreide, Kjetil
AU - Di Saverio, Salomone
AU - Assarsson, Jeanette Hansson
AU - Drake, Frederick Thurston
N1 - Copyright © 2015 Elsevier Ltd. All rights reserved.
PY - 2015/9/26
Y1 - 2015/9/26
N2 - Acute appendicitis is one of the most common abdominal emergencies worldwide. The cause remains poorly understood, with few advances in the past few decades. To obtain a confident preoperative diagnosis is still a challenge, since the possibility of appendicitis must be entertained in any patient presenting with an acute abdomen. Although biomarkers and imaging are valuable adjuncts to history and examination, their limitations mean that clinical assessment is still the mainstay of diagnosis. A clinical classification is used to stratify management based on simple (non-perforated) and complex (gangrenous or perforated) inflammation, although many patients remain with an equivocal diagnosis, which is one of the most challenging dilemmas. An observed divide in disease course suggests that some cases of simple appendicitis might be self-limiting or respond to antibiotics alone, whereas another type often seems to perforate before the patient reaches hospital. Although the mortality rate is low, postoperative complications are common in complex disease. We discuss existing knowledge in pathogenesis, modern diagnosis, and evolving strategies in management that are leading to stratified care for patients.
AB - Acute appendicitis is one of the most common abdominal emergencies worldwide. The cause remains poorly understood, with few advances in the past few decades. To obtain a confident preoperative diagnosis is still a challenge, since the possibility of appendicitis must be entertained in any patient presenting with an acute abdomen. Although biomarkers and imaging are valuable adjuncts to history and examination, their limitations mean that clinical assessment is still the mainstay of diagnosis. A clinical classification is used to stratify management based on simple (non-perforated) and complex (gangrenous or perforated) inflammation, although many patients remain with an equivocal diagnosis, which is one of the most challenging dilemmas. An observed divide in disease course suggests that some cases of simple appendicitis might be self-limiting or respond to antibiotics alone, whereas another type often seems to perforate before the patient reaches hospital. Although the mortality rate is low, postoperative complications are common in complex disease. We discuss existing knowledge in pathogenesis, modern diagnosis, and evolving strategies in management that are leading to stratified care for patients.
KW - Appendectomy
KW - Appendicitis
KW - Diagnosis, Differential
KW - Humans
KW - Journal Article
KW - Review
U2 - 10.1016/S0140-6736(15)00275-5
DO - 10.1016/S0140-6736(15)00275-5
M3 - Article
C2 - 26460662
SN - 0140-6736
VL - 386
SP - 1278
EP - 1287
JO - The Lancet
JF - The Lancet
IS - 10000
ER -