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Acute Appendicitis in the Young

• diagnosis of acute appendicitis is more difficult in young children than in

the adult
• The more rapid progression to rupture and the inability of the
underdeveloped greater omentum to contain a rupture lead to significant
morbidity rates in children
• The incidence of intra-abdominal abscess also is higher after the
treatment of perforated appendicitis than after nonperforated
appendicitis (6% vs. 3%).
• The treatment regimen for perforated appendicitis generally includes
immediate appendectomy and irrigation of the peritoneal cavity
• For perforated appendicitis IV antibiotics usually are given until the white
blood cell count is normal and the patient is afebrile for 24 hours
• Antibiotic coverage is limited to 24 to 48 hours in cases of nonperforated
• Laparoscopic appendectomy has been shown to be safe and effective for
the treatment of appendicitis in children
Acute Appendicitis in the Elderly
• elderly patients with appendicitis often pose a more difficult diagnostic
problem because of the atypical presentation, expanded differential
diagnosis, and communication difficulty
• Elderly patients usually present with lower abdominal pain, but on clinical
examination, localized right lower quadrant tenderness is present in only
80 to 90% of patients
• The usefulness of the Alvarado score appears to decline in the elderly.
Fewer then 50% of the elderly with appendicitis have an Alvarado score of
• In general, laparoscopic appendectomy offers elderly patients with
appendicitis a shorter length of hospital stay, a reduction in complication
and mortality rates, and a greater chance of discharge to home
(independent of further nursing care or rehabilitation).
Acute Appendicitis during Pregnancy
• Appendectomy for presumed appendicitis is the most common surgical
emergency during pregnancy. The incidence is approximately 1 in 766
• The most consistent sign encountered in acute appendicitis during
pregnancy is pain in the right side of the abdomen
• Laboratory evaluation is not helpful in establishing the diagnosis of acute
appendicitis during pregnancy
• American College of Radiology recommends the use of nonionizing
radiation techniques for front-line imaging in pregnant women
• The overall incidence of fetal loss after appendectomy is 4% and the risk
of early delivery is 7%
• Because the incidence of ruptured appendix is similar in pregnant and
nonpregnant women and because maternal mortality is so low, it appears
that the greatest opportunity to improve fetal outcomes is by improving
diagnostic accuracy and reducing the rate of negative appendectomy.
Appendicitis in Patients with AIDS or HIV Infection

• The incidence of acute appendicitis in HIV-infected patients is reported to be

0.5%. This is higher than the 0.1 to 0.2% incidence reported for the general
• The risk of appendiceal rupture appears to be increased in HIV-infected
• opportunistic infections should be considered as a possible cause of right
lower quadrant pain. Such opportunistic infections include cytomegalovirus
(CMV) infection, Kaposi's sarcoma, tuberculosis, lymphoma, and other causes
of infectious colitis
• In the HIV-infected
-patient with classic signs and symptoms of appendicitis, immediate
appendectomy is indicated.
-In those patients with diarrhea as a prominent symptom, colonoscopy
may be warranted.
-In patients with equivocal findings, CT scan is usually helpful