Appendicitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farwa Haideri [2]

Overview

Appendicitis can lead to death if peritonitis develops from the rupturing of the appendix and is left untreated. Acute appendicitis that is evaluated and treated early with an appendectomy generally leads to no further complications and a patient's full recovery.

Natural History

• The symptoms of appendicitis typically develop shortly after inflammation of the appendix.
• Without treatment, the patient will likely develop symptoms of pain, starting centrally (in the periumbilical region) before localizing to the right iliac fossa in the right lower quadrant of the abdomen.
  • They will also experience loss of appetite, diarrhea, fever, nausea, and vomiting.
  • During the final stage of the untreated disease process, the appendix will rupture, and this may eventually lead to death if peritonitis develops.

Complications

Most complications that can develop as a result of the treatment of appendicitis include:

• Abnormal connections between abdominal organs or between these organs and the skin surface (fistula)
• Abscess
• Rupture
• Infection of the surgical wound
• Peritonitis

Prognosis

• Most patients with appendicitis recover quickly with surgical treatment (laparoscopic appendectomy), but complications can occur if treatment is delayed or if peritonitis occurs.
• Recovery time depends on age, condition, complications, and other aspects in the patient's history (including amount of alcohol consumption).
  • It usually takes between 10 and 28 days to recover completely.
• For young children (around 10 years old), recovery takes three weeks.
• Typical acute appendicitis responds quickly to appendectomy and occasionally will resolve spontaneously.
  • If appendicitis resolves spontaneously, it remains controversial whether an elective interval appendectomy should be performed to prevent a recurrent episode of appendicitis.
• Atypical appendicitis (associated with suppurative appendicitis) is more difficult to diagnose and is more apt to be complicated, even when operated on early.
  • In either condition, prompt diagnosis and appendectomy yield the best results with full recovery usually occurring in two to four weeks.
• Mortality and severe complications are unusual but do occur in some cases of appendicitis, especially if peritonitis develops and is left untreated.