Appendicitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
If left untreated, appendicitis can lead to death if peritonitis develops from the rupturing of the appendix. Acute appendicitis that is evaluated and treated early with an appendectomy generally leads to no further complications and to a full recovery of the patient depending on some individual factors.
Natural History
The symptoms of Appendicitis typically develop acutely after the inflammation of the appendix. Without treatment, the patient will likely develop symptoms of pain starting centrally (periumbilical) before localizing to the right iliac fossa, loss of appetite, diarrhea, fever, nausea, and vomiting which may eventually lead to death if peritonitis occurs due to appendiceal bursting.
Complications
In cases of acute appendicitis, life-threatening peritonitis can occur if the appendix bursts. It is for this reason that appendicitis cases are evaluated and treated speedily.
Prognosis
- Most appendicitis patients recover easily with treatment, but complications can occur if treatment is delayed or if peritonitis occurs.
- Recovery time depends on age, condition, complications, and other circumstances, including the amount of alcohol consumption, but usually is between 10 and 28 days. For young children (around 10 years old) the 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 early.
- In either condition prompt diagnosis and appendectomy yield the best results with full recovery in two to four weeks usually.
- Mortality and severe complications are unusual but do occur in cases of appendicitis, especially if peritonitis persists and is untreated