title: Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management.
abstract: 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.
authors.affiliation: Academic Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham UK; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Aneel
authors.initials: A
authors.lastname: Bhangu
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: ksoreide@mac.com.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
authors.affiliation: Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna, Italy.
authors.forename: Salomone
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Department of Surgery, Kalmar County Hospital, Kalmar, Sweden.
authors.forename: Jeanette Hansson
authors.initials: JH
authors.lastname: Assarsson
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA.
authors.forename: Frederick Thurston
authors.initials: FT
authors.lastname: Drake
mesh_terms: D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans