Assessment of acute appendicitis
Appendicitis involves inflammation of the appendiceal wall, which may be followed by localised appendiceal ischaemia or associated with complications. The incidence of acute appendicitis is declining; children remain most commonly affected.
Complicated appendicitis is defined as acute appendicitis complicated by one or more ofCoda Collaborative 2020Keighley 2021:
- gangrenous appendix
- perforated appendix
- periappendicular abscess
- peritonitis caused by spill of the appendiceal contents
- evidence of sepsis or septic shock.
Ultrasound or computed tomography (CT) can be used to assist diagnosis and assess for signs of complicated appendicitis, which determines appropriate management. Presence of an appendicolith on imaging increases the risk of complicated appendicitis. Ultrasound is preferred for children, young adults and pregnant patients, to avoid radiation from CT. Magnetic resonance imaging (MRI) is highly sensitive and specific and may be used for patients with inconclusive findings on ultrasound or CT.
See also Assessment of intra-abdominal infections.