What is acute appendicitis?
Acute appendicitis is acute inflammation of the appendix — a small tubular blind-ended diverticulum of the cecum. It is the most common surgical emergency intra-abdominal condition worldwide and requires prompt diagnosis and treatment.
It is classified as uncomplicated (inflammatory), perforated and "appendiceal mass". Prompt and proper surgical management prevents complications such as diffuse peritonitis, intra-abdominal abscess and sepsis.
How common is it?
The lifetime risk of developing acute appendicitis is estimated at 7–8% (approximately 1 in 13). It occurs at all ages, with peak incidence between 10 and 30 years. It is approximately equally frequent in men and women, with a slight male predominance.
In Greece, approximately 25,000–30,000 appendectomies are performed annually. Today, the vast majority are performed by laparoscopic technique.
How does it present?
The main symptoms of acute appendicitis include:
- Pain that starts around the umbilicus and within hours migrates to the right iliac fossa.
- Anorexia (almost always present).
- Nausea and vomiting, typically after the onset of pain.
- Low-grade fever (38–38.5°C).
- Pain worsened by movement, coughing or by pressure/release at McBurney's point.
- Possible constipation or rarely diarrhea.
- In perforation: generalised tenderness and rigid abdomen (guarding).
How is it diagnosed?
Diagnosis is often clinical, supplemented by laboratory and imaging investigations:
- Clinical examination: McBurney's point, Rovsing's sign, psoas sign, obturator sign.
- Complete blood count (leukocytosis with neutrophilia), CRP.
- Urinalysis to exclude urinary tract infection.
- Abdominal ultrasound — first-line investigation, particularly in children and young women.
- Abdominal CT with contrast — excellent accuracy, particularly in doubtful cases.
- In women of reproductive age: exclusion of gynaecological cause with pelvic ultrasound.
Which factors increase risk?
There is no specific genetic predisposition. A slightly increased frequency is however observed in individuals with a positive family history of appendicitis (probably due to anatomical variations).
- Family history of appendicitis — approximately 3-fold risk.
- Young age (10–30 years).
- Infection or obstruction of the appendix (faecolith, lymphoid hyperplasia).
- Parasitic infestations (rare in the West).
- Diet low in fibre (controversial).
- Inflammatory bowel disease.
Modern therapeutic options
The choice of the appropriate technique is individualised for each patient, based on disease stage, anatomy, comorbidities and patient preference.
Laparoscopic Appendectomy
International gold standard for uncomplicated and complicated appendicitis. Performed through 3 small incisions (1×10mm, 2×5mm). Advantages: excellent visualisation of the entire abdomen, lower wound infection rate, rapid recovery, better cosmetic outcome.
Antibiotic Therapy (selected cases)
In selected cases of uncomplicated appendicitis or appendiceal mass, initial treatment may be antibiotic. However there is a 30–40% one-year recurrence risk — definitive treatment remains appendectomy.
Open Appendectomy
Rare today — reserved for cases of generalised peritonitis with sepsis or in patients with very complex surgical history. The classic McBurney incision remains a safe option.
Frequently asked questions
Is it safe to wait 24 hours?
In confirmed acute appendicitis, treatment must take place within hours to avoid perforation. In doubtful cases, active observation with re-evaluation is acceptable.
Can I be treated with antibiotics alone?
In selected, uncomplicated cases, yes. However, half of patients will experience recurrence within the next 5 years. Appendectomy remains the definitive treatment.
Will I have symptoms after the operation?
No. The appendix has no significant functional role. Patients return to a fully normal life without dietary or other restrictions.
How quickly can I return to work?
With laparoscopic technique, most patients return to office work in 5–7 days. For physical work or sport, 2–3 weeks.