Appendicitis historical perspective

Appendicitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Appendicitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Diagnostic Scoring
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Appendicitis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Appendicitis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Appendicitis
CDC on Appendicitis
Appendicitis in the news
Blogs on Appendicitis
Directions to Hospitals Treating Appendicitis
Risk calculators and risk factors for Appendicitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Appendicitis was first described

Discovery

• The knowledge of the appendix itself dates back to ancient Egypt. Coptic jars from from the ancient egyptian times refer to "the worm of the intestine". The earliest known drawing of the appendix was by the great artist and scientist, Leonardo da Vinci, in 1492. The first description of the appendix was by Physician and Anatomist Jacopo Berengaro Dan Carpi in 1521. In 1543, Andrea Vasulius portrayed a clear illustration of the appendix in "De Humani Corporis Fabrica.
• The first description of appendicitis is thought to date back to the early 1500's by French doctor and prolific writer, Jean Francois Fernel, in the "Universa Medicina". He describes a patient:

"A girl of seven afflicted with diarrhoea passed for many days from the bowels a white putrid and foul material. She swelled up with increasingly severe pains and repeated loss of consciousness and vomiting of a fecal liquid. She died miserably two days later. On opening the body, the caecum intestinum was narrowed and constricted....and material opened up itself an unusual route by necrosis and perforation".

• Lorenz Heister in the late 1600's was the first person to perform post-mortem sections of appendicitis, and gave an unequivocal description of a perforated appendix and abscess .
• Francois Melier suggested surgical removal of the appendix in 1827, although his paper was largely ignored. Guillaume Dupuytren, a leading surgeon in Paris gave strong opposition to Melier's suggestion, and was convinced that the cause of right lower quadrant inflammatory disease was due to the cecum . Finally in the 1840's, four well known physicians of the time Thomas Hodgkin, Voltz, Addison and Bright all pointed towards the appendix as the source of the disease.
• There was no definitive treatment for over 50 years after Melier's paper, and the disease was called many names, such as typhilitis, pertyphilitis, tuphloenteritis, paratyphilitis, cecitis and iliac passion.
• Reginald. J. Fitz, anatomic pathologist from Harvard University, described his paper "Perforating Inflammation of the Vermiform Appendix" on 18th June 1886 to the Association of American Physicians . He was the first person to provide a clear description of the pathology, diagnosis and treatment of appendicitis. This is when the term "appendicitis" was used for the first time.
• The first actual surgical removal of the appendix was done by Caudius Amyand at St. Georges Hospital in London, when he removed a perforated appendix found in a scrotal hernia.

Development of Treatment Strategies

• Charles McBurney from the College of Physicians and Surgeons in New York city, pioneered the diagnosis and early operative intervention of appendicitis.
• The McBurney point was described in 1889, which is one third of the way from the anterior superior iliac spine in the right upper quadrant of the abdomen.
• The McBurney incision was coined in 1894.
• A.J. Oschner in 1902, advocated for a non-operative treatment of peritonitis, and he stated:

"After my first operation I was completely disgusted because after cutting my patient lengthwise and crosswise, I found, behind the ascending colon, an inoffensive looking, shriveled up remains of what had been an appendix. I felt that I had subjected my patient to a very grave operation without a corresponding benefit".

• The laparoscopic surgery was invented in 1980 by Semm.

Impact on Cultural History

• The appendectomy has become one of the most common surgical procedures.
• Advances in modern surgery, anesthesia, antibiotics, and imaging have lead to an improved outcome and a significant reduction in mortality.
• Laparoscopic surgery has lead to a decreased length of hospital stay, reduced risk of wound infection, reduced amount of post-operative pain, and more rapid return to daily activities for the patient.