How is it Diagnosed?
Acute appendicitis is a common surgical emergency caused by inflammation of the
appendix, typically due to obstruction. The diagnosis starts with a focused clinical
history—periumbilical pain that migrates to the right lower quadrant (RLQ), nausea,
vomiting, anorexia, and low-grade fever.
Physical examination reveals RLQ tenderness, especially at McBurney’s point. Classical
signs include Rovsing's, Psoas, and Obturator signs, which suggest peritoneal irritation.
Rebound tenderness and guarding are also common.
Initial laboratory tests show elevated white blood cell count (WBC) with neutrophilia. Creactive protein (CRP) may also be elevated, supporting the inflammatory process.
Imaging studies play a critical role in confirming the diagnosis. Ultrasound is preferred in
children and pregnant women, showing a non-compressible, dilated appendix. In adults,
CT scan of the abdomen and pelvis with contrast is the most accurate, demonstrating a
dilated appendix (>6 mm), wall thickening, peri-appendiceal fat stranding, or abscess
formation.
In equivocal cases, diagnostic laparoscopy may be both diagnostic and therapeutic.
Prompt diagnosis is crucial, as delayed treatment increases the risk of perforation and
peritonitis. Hence, appendicitis is often a clinical diagnosis supported by imaging and
labs.