What are the early symptoms of appendicitis. How do symptoms differ among age groups. When should you seek medical attention for suspected appendicitis. What diagnostic procedures are used to confirm appendicitis.

Understanding Appendicitis: Causes and Prevalence

Appendicitis occurs when the appendix, a small pouch attached to the large intestine, becomes inflamed. This condition is the most common cause of acute abdominal pain requiring surgery in the United States, affecting over 5% of the population at some point in their lives. While appendicitis can develop at any age, it is most prevalent during the teenage years and twenties.

The appendix is approximately 4 inches long and located on the lower right side of the abdomen. It is a tube-shaped structure closed at one end and connected to the cecum, a pouch-like portion of the colon. Despite its presence, the exact function of the appendix remains a topic of debate among medical professionals.

Recognizing the Early Symptoms of Appendicitis

Identifying the early signs of appendicitis is crucial for prompt treatment and prevention of complications. The most common initial symptom is sudden and severe abdominal pain, which often begins near the belly button and gradually shifts to the lower right side of the abdomen. This pain typically intensifies over the next few hours and may worsen with movement, deep breathing, coughing, or sneezing.

Classic Symptoms of Appendicitis

• Nausea and vomiting
• Loss of appetite
• Constipation or diarrhea
• Inability to pass gas
• Low-grade fever (99°F to 102°F) and chills
• Abdominal swelling
• Feeling the need to have a bowel movement for relief

It’s important to note that these classic symptoms only appear in about 50% of cases. Some individuals may experience minimal stomach pain or no pain at all, while others may present with less common symptoms.

Age-Specific Manifestations of Appendicitis

The presentation of appendicitis can vary significantly across different age groups, making diagnosis challenging in certain populations.

Appendicitis in Children and Infants

In younger patients, appendicitis may manifest differently compared to adults. Children and infants might not experience localized pain and instead have generalized abdominal tenderness or no pain at all. Bowel movements may be less frequent or absent, and diarrhea could indicate a different illness. Despite these variations, research suggests that abdominal pain remains the most common symptom of appendicitis in pediatric patients.

Appendicitis in Older Adults and Pregnant Women

Older adults and pregnant women may also experience atypical symptoms. The abdominal pain might be less severe and less specific. Common symptoms in these groups include nausea, vomiting, and fever. For pregnant women, the pain may shift upward toward the upper right quadrant of the abdomen after the first trimester, and they may also experience back or flank pain.

Differential Diagnosis: Conditions Mimicking Appendicitis

Several conditions can present with symptoms similar to appendicitis, making accurate diagnosis crucial. These include:

1. Stomach lesions
2. Constipation
3. Inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis
4. Obstructions within the appendix (e.g., stool, parasites, or growths)
5. Abdominal injuries or trauma

Given the overlap in symptoms, healthcare providers must conduct a thorough evaluation to differentiate appendicitis from these other conditions.

When to Seek Medical Attention for Suspected Appendicitis

Appendicitis is a potentially life-threatening condition that requires immediate medical care. The severity of the condition tends to worsen the longer it remains untreated. If you experience persistent abdominal pain, especially if it’s accompanied by other symptoms like fever, nausea, or vomiting, it’s crucial to seek medical attention promptly.

Initially, the discomfort may feel similar to gas pain. However, if over-the-counter medications fail to provide relief or if the pain becomes severe and worsens, it’s advisable to consult a healthcare provider immediately. In cases of severe pain or rapid symptom progression, going directly to the emergency room may be the best course of action.

Diagnostic Procedures for Appendicitis

When a patient presents with suspected appendicitis, healthcare providers typically follow a systematic approach to diagnosis. This process involves several steps to confirm the condition and rule out other potential causes of abdominal pain.

Symptom Review

The healthcare provider will begin by asking detailed questions about the patient’s symptoms, including their nature, severity, and duration. This information helps create a preliminary assessment of the likelihood of appendicitis.

Medical History Evaluation

A thorough review of the patient’s medical history is crucial to rule out other potential health issues. The healthcare provider will inquire about:

• Any existing medical conditions or previous surgeries
• Current medications and supplements
• Alcohol consumption and recreational drug use

Physical Examination

A comprehensive physical exam is performed to assess the patient’s abdominal pain. The healthcare provider will apply pressure to or palpate specific areas of the abdomen to identify areas of tenderness or pain. In some cases, pelvic and rectal exams may also be conducted to gather additional information.

Laboratory Tests

Blood and urine tests play a vital role in confirming an appendicitis diagnosis and detecting signs of other potential health issues. These tests can help identify markers of inflammation and infection that are commonly associated with appendicitis.

Imaging Studies for Appendicitis Diagnosis

In addition to the initial diagnostic steps, imaging studies are often employed to visualize the appendix and surrounding structures. These imaging techniques can provide valuable information to confirm or rule out appendicitis.

Computed Tomography (CT) Scan

A CT scan is a highly accurate imaging method for diagnosing appendicitis. It can reveal inflammation of the appendix, as well as other abdominal abnormalities that may be causing similar symptoms. CT scans are particularly useful in cases where the diagnosis is uncertain based on clinical examination alone.

Ultrasound

Ultrasound imaging is often the first-line imaging technique, especially in children and pregnant women, as it does not involve radiation exposure. It can help visualize the appendix and detect signs of inflammation. However, ultrasound may be less reliable in adults or in cases where the appendix is not easily visible.

Magnetic Resonance Imaging (MRI)

MRI is sometimes used as an alternative to CT scans, particularly in pregnant women or when radiation exposure is a concern. It can provide detailed images of the appendix and surrounding tissues without the use of ionizing radiation.

Treatment Options for Appendicitis

Once appendicitis is diagnosed, prompt treatment is essential to prevent complications. The standard treatment for appendicitis is surgical removal of the inflamed appendix, known as an appendectomy.

Appendectomy Procedures

There are two main types of appendectomy procedures:

1. Laparoscopic Appendectomy: This minimally invasive procedure involves making small incisions in the abdomen and using specialized instruments to remove the appendix. It typically results in a faster recovery time and less postoperative pain.
2. Open Appendectomy: In some cases, such as when the appendix has ruptured or when there are complications, an open surgery may be necessary. This involves a larger incision in the lower right abdomen to access and remove the appendix.

Antibiotic Treatment

In certain cases of uncomplicated appendicitis, antibiotic therapy may be considered as an alternative to surgery. This approach is more commonly used in patients who are poor surgical candidates or in situations where immediate surgery is not feasible. However, it’s important to note that antibiotics alone may not be sufficient in all cases, and close monitoring is required to ensure resolution of the inflammation.

Potential Complications of Untreated Appendicitis

Leaving appendicitis untreated can lead to severe complications that can be life-threatening. Understanding these potential risks underscores the importance of seeking prompt medical attention when appendicitis is suspected.

Appendix Rupture

If left untreated, the inflamed appendix can rupture or perforate, spilling its contents into the abdominal cavity. This can lead to a serious condition called peritonitis, which is an inflammation of the abdominal lining. Peritonitis is a medical emergency that requires immediate surgical intervention and intensive antibiotic therapy.

Abscess Formation

In some cases, the body may wall off the infection caused by a perforated appendix, forming an abscess. While this can temporarily contain the infection, it still requires treatment, often involving drainage of the abscess followed by antibiotics and possibly delayed surgery.

Sepsis

If the infection from appendicitis spreads throughout the body, it can lead to sepsis, a life-threatening condition characterized by a systemic inflammatory response. Sepsis requires immediate and aggressive treatment in an intensive care setting.

Prevention and Risk Factors for Appendicitis

While there is no guaranteed way to prevent appendicitis, certain factors may influence its occurrence. Understanding these factors can help individuals make informed decisions about their health and lifestyle.

Diet and Lifestyle

Some studies suggest that a diet high in fiber may help reduce the risk of appendicitis. Fiber-rich foods, such as fruits, vegetables, and whole grains, can promote regular bowel movements and potentially decrease the risk of appendix obstruction. Additionally, maintaining good hygiene practices may help prevent infections that could lead to appendicitis.

Genetic Factors

There is some evidence to suggest that appendicitis may have a genetic component. Individuals with a family history of appendicitis may be at a slightly higher risk of developing the condition themselves.

Environmental Factors

Some research indicates that environmental factors, such as air pollution and certain infections, may play a role in the development of appendicitis. However, more studies are needed to fully understand these potential associations.

In conclusion, recognizing the early symptoms of appendicitis and seeking prompt medical attention are crucial for preventing complications and ensuring successful treatment. While the classic symptoms are well-documented, it’s important to remember that presentation can vary, especially among different age groups. By staying informed about the signs and risk factors associated with appendicitis, individuals can take proactive steps to protect their health and well-being.

Early symptoms and warning signs

Appendicitis happens when the appendix becomes inflamed. Early symptoms can vary between age groups, and they can be confused with symptoms of other conditions.

The symptoms can be uncomfortable, painful, and potentially life-threatening if left untreated, so it is important to be able to recognize them.

Sudden appendicitis is the most common cause of acute abdominal pain requiring surgery in the United States (U.S.), with over 5 percent of the population developing appendicitis at some point.

It most commonly occurs during the teenage years and the 20s, but it can develop at any age.

Fast facts on appendicitis:

• Early symptoms include a pain near the belly button that may shift toward the lower right-hand side of the abdomen.
• If treatment for gas does not solve the problem, prompt medical attention should be sought.
• Many people with suspected appendicitis will go directly to the emergency department.
• Early treatment is usually successful, but untreated appendicitis can lead to fatal complications.

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Share on PinterestAppendicitis can cause pain in the lower, right-hand side of the abdomen.

The appendix is about 4 inches long and is situated on the right, lower side of the abdomen. It is a tube-shaped piece of tissue that is closed at one end. It is attached to the cecum, a pouch-like portion of the colon, or large intestine.

Severe and sudden abdominal pain is usually the first symptom of appendicitis.

The pain often begins near the belly button. As it worsens, it will likely shift to the lower right side of the abdomen.

The feeling may become more intense within the next few hours and be worsened by moving around, taking deep breaths, coughing, or sneezing.

Other classic symptoms of appendicitis are:

• nausea
• vomiting
• loss of appetite
• constipation or diarrhea
• inability to pass gas
• low-grade fever and chills
• a temperature between 99° and 102° Fahrenheit
• stomach swelling
• wanting to have a bowel movement to relieve discomfort

However, these symptoms appear in only 50 percent of cases.

Some patients may experience symptoms such as stomach pain very slightly or not at all. Others may have less common symptoms.

Symptoms in children and infants

Children and infants may not experience pain in one specific area. There may be tenderness throughout the body, or there may be no pain.

Children and infants may have less frequent or no bowel movements. If diarrhea occurs, this may be a symptom of another illness.

While children and infants may not experience precise pain as older patients do, research suggests that abdominal pain is still the most common symptom of appendicitis symptom for this age group.

Symptoms in older adults and during pregnancy

Older adults and pregnant women may also experience different symptoms. The stomach pain may be less severe and less specific. Possible symptoms include nausea, vomiting, and fever.

During pregnancy, the pain may shift upward toward the upper right quadrant after the first trimester. There may also be some back or flank pain.

If there is stomach pain, this may result from another condition.

Other conditions with similar symptoms

Abdominal pain can be a symptom of other conditions that seem like appendicitis.

Examples include:

• stomach lesions
• constipation
• inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis
• stool, parasites, or growths that clog the inside of the appendix
• damage or injury to the abdomen

When to see a doctor

Appendicitis can be life-threatening, and it requires immediate medical care. It is likely to worsen the longer it is left untreated. Initial symptoms may feel like gas.

If over-the-counter (OTC) medications do not relieve the gas, or if there is severe and worsening pain, the individual should see a doctor at once. It may be advisable to go straight to the emergency room.

Treating appendicitis as soon as symptoms appear will prevent it from worsening and causing further complications.

A healthcare provider will normally diagnose appendicitis by doing the following:

Reviewing the symptoms

The patient will be asked to provide details about what symptoms they are experiencing, how severely, and for how long.

Reviewing the patient’s medical history

To rule out other potential health issues, the doctor will want to know details about the patient’s medical history.

These include:

• any other medical conditions or surgeries the patient has or has had in the past
• whether the patient takes any medications or supplements
• whether the patient drinks alcohol or takes any recreational drugs

Doing a physical exam

The doctor will do a physical exam to find out more about the patient’s stomach pain. They will apply pressure to or touch certain areas of the abdomen. Pelvic and rectal exams may also be used.

Ordering laboratory tests

Blood and urine tests can help confirm an appendicitis diagnosis or detect signs of other health issues. A doctor may also ask for blood or urine samples to check for pregnancy.

If necessary, the doctor may also order imaging tests, such as an abdominal ultrasound, MRI exam, or CT scan.

These imaging tests can show:

• an enlarged or burst appendix
• inflammation
• a blockage inside the appendix
• an abscess

Treatment normally begins with antibiotics and intravenous fluid. Some mild cases of appendicitis can be treated completely with fluids and antibiotics.

The most common next step is surgery, known as an appendectomy. Removing the appendix decreases the risk of it rupturing. Early treatment is important to reduce the risk of complications, which can lead to death.

Two types of surgery are possible:

Laparoscopic surgery

Surgeons make several small incisions and use special tools to remove the appendix through them.

Benefits of laparoscopic surgery include:

• a lower risk of complications, such as hospital-related infections
• shorter recovery time

Patients should limit their physical exercise for the first 3 to 5 days after surgery.

Laparotomy surgery

Surgeons remove the appendix through a single incision made in the lower right area of the abdomen. This may be necessary for a burst appendix.

It allows the surgeon to clean the inside of the abdomen to prevent infection.

Patients should limit their physical activity for the first 10 to 14 days after a laparotomy surgery.

Delaying treatment can seriously increase the risk of complications.

Inflammation can cause the appendix to rupture, sometimes as soon as 48 to 72 hours after the symptoms begin.

A rupture can cause bacteria, stool, and air to leak into the abdomen, causing infection and further complications, which can be fatal.

Infections that can result from a burst appendix include peritonitis, an inflammation of the lining of the abdomen, or an abscess.

Taking pain medications can potentially mask symptoms and delay treatment.

With prompt treatment, appendicitis is treatable, and recovery is normally fast and complete. With early surgery, the mortality rate is under 1 percent.

Without surgery or antibiotics, for example, in remote areas, the mortality rate can be 50 percent or higher.

If the appendix bursts, this can lead to complications, such as an abscess or peritonitis. Recovery may be lengthy in these cases. Older people make also take longer to recover.

The appendix is often considered a nonfunctioning organ, unnecessary for survival, but some scientists suggest that it may play a role in maintaining a healthy immune system.

Read the article in Spanish.

Chronic appendicitis: Symptoms, treatment, and outlook

Chronic appendicitis is long-lasting inflammation of the appendix. Though rare, it can become extremely painful and, in some cases, life-threatening.

In this article, we look at the symptoms and diagnosis of chronic appendicitis, as well as how the condition is treated.

Share on PinterestThe appendix is connected to the bottom of the large intestine.

The appendix is a small pouch shaped like a finger or sausage. It is connected to the bottom of the large intestine. Appendicitis occurs when the appendix becomes inflamed and infected. The first noticeable symptom of appendicitis is usually abdominal pain.

People with chronic appendicitis have appendicitis that lasts for long periods of time. This means appendicitis that is present for longer than a week.

Chronic appendicitis is relatively rare, with just an estimated 1.5 percent of all appendicitis cases being considered chronic appendicitis.

Chronic appendicitis may occur for many different reasons and many cases do not have a clear cause.

Often, chronic appendicitis occurs due to inflammation and obstruction of the appendix. Other possible causes include:

• accumulation of fecal matter, which can happen if someone is constipated
• calcified fecal deposits, also known as ‘appendix stones’
• trauma to the abdomen
• tumors
• enlarged lymph nodes and glands
• worms
• a buildup of foreign objects, such as stones, marbles, or pins

Share on PinterestMild abdominal pain may be the first symptom of chronic appendicitis.

Chronic appendicitis can be difficult to diagnose, as symptoms may be fairly mild and easily mistaken for a different condition.

Many people experience mild abdominal pain at first, and this may remain as their only symptom.

The pain is usually located on the lower right side of the abdomen but can spread towards the belly button. The pain can either be dull or sharp.

As well as abdominal pain, people with chronic appendicitis may also experience the following symptoms:

• fever
• swelling and tenderness of the abdomen
• feeling tired and having no energy
• nausea or diarrhea
• malaise or a general feeling of being unwell

Not all people with chronic appendicitis will have all of these symptoms. Symptoms may also subside on their own and then return, making it more challenging for doctors to give an accurate diagnosis if a person is not experiencing the symptoms at the time.

However, because chronic appendicitis can become life-threatening, it is important that people with recurrent abdominal pain and the above symptoms seek medical attention, particularly if the symptoms become more severe.

While chronic and acute appendicitis have similar symptoms, there are important differences between them.

Chronic appendicitis is where a person has symptoms that last for a long time, and these symptoms usually come and go. If chronic appendicitis is not diagnosed, the person can continue to experience symptoms for years.

Acute appendicitis is when a person suddenly develops severe symptoms, typically over the course of 24–48 hours. These symptoms will be impossible to ignore and require immediate emergency medical treatment.

The most typical symptom of acute appendicitis is abdominal pain that starts around the belly button and moves to the lower right side of the tummy. This pain may start out as mild and dull, but is likely to intensify.

Other symptoms of acute appendicitis include:

• nausea with or without vomiting
• low-grade fever
• constipation or diarrhea
• lack of appetite
• inability to pass gas

Appendicitis usually occurs when an obstruction, such as a foreign object or calcified stool, blocks the inner cavity or appendiceal lumen of the appendix.

Chronic appendicitis may occur when the appendiceal lumen is only partially blocked. However, the blockage is likely to worsen over time by causing pressure to build.

When this happens in people with chronic appendicitis, the pressure may overcome the partial obstruction and the symptoms will reduce in intensity or go away altogether.

The symptoms will then return the next time the blockage causes the appendix to become inflamed.

Share on PinterestAn appendectomy is the most common treatment for chronic appendicitis.

A doctor will initially do a physical exam to determine whether the abdomen is tender and where the pain is located. They will also ask questions about the symptoms and a person’s medical history.

In most cases, a doctor will do several tests to rule out other medical conditions that have the same symptoms.

The conditions the doctor may attempt to rule out include:

• urinary tract infection
• kidney infection
• Crohn’s disease
• ulcerative colitis
• ovarian cysts
• pelvic inflammatory disease (PID)
• irritable bowel syndrome (IBS)
• other gastrointestinal disorders

The tests used to rule out these conditions include:

• blood tests
• a pelvic exam
• a pregnancy test
• urinalysis or testing a person’s urine
• computerised tomography (CT) scan
• abdominal ultrasound
• magnetic resonance imaging (MRI)

If chronic appendicitis is diagnosed, the doctor may prescribe antibiotics or may advise draining the pus that has formed around the appendix due to the infection.

The most common treatment, however, is to have the appendix removed altogether. This surgery is called an appendectomy.

An appendectomy is usually performed using laparoscopic surgery, which is minimally invasive. It is also known as keyhole surgery and is performed under general anesthetic.

The most common complications of chronic appendicitis are:

• acute appendicitis
• a ruptured appendix or when a person’s appendix bursts
• an abscess or when a pocket of pus develops around the appendix
• sepsis or when chemicals are released into the bloodstream, causing the whole body to become inflamed
• peritonitis or inflammation of the abdomen’s lining

The above complications are serious and require immediate medical care. It is vital not to ignore symptoms of appendicitis, and to seek medical attention urgently.

Outlook

Chronic appendicitis is a long-term condition characterized by appendicitis symptoms that come and go over time. It is different from acute appendicitis, but it can also have serious complications.

While a person may live with chronic appendicitis for years, it is important that they do not ignore the symptoms. Recurring pain in the lower abdomen can be a symptom of many underlying conditions, so it is vital to get a proper diagnosis.

Acute appendicitis | MyPathologyReport.ca

Madeleine Fitzpatrick, MD, and Stephanie Reed, MD, FRCPC
March 6, 2023

What is acute appendicitis?

Acute appendicitis is a non-cancerous disease caused by: acute inflammation in the appendix a small finger-shaped organ that connects to the large intestine (colon) through a small opening. For most people, the appendix is ​​located in the lower right side of the abdomen, just above the pelvic bone. Acute appendicitis can occur in any age group but most commonly affects teenagers and young adults.

What causes acute appendicitis?

In acute appendicitis, the small opening of the appendix is ​​blocked, often by a piece of overcooked food called feces. When the hole is blocked, bacteria that normally live in the colon fills up the appendix. Your immune system responds by sending specialized immune cells called neutrophils to surround and destroy the bacteria. The combination of bacteria and neutrophils leads to the formation of pus.

What are the symptoms of acute appendicitis?

Patients with acute appendicitis usually experience gradual, constant pain that starts near the navel and progresses to the right lower abdomen. Other possible symptoms may include nausea, vomiting, loss of appetite, diarrhea, and fever.

How is acute appendicitis diagnosed?

The diagnosis is made after the appendix is ​​surgically removed and sent to a pathologist for examination under a microscope. If your doctor suspects acute appendicitis, they will order a blood test and x-ray imaging, such as an ultrasound or CT scan. Your blood test usually shows a large number of immune cells called white blood cells (WBCs). An ultrasound or CT scan usually shows an enlarged appendix. Acute appendicitis is most often treated by removing the appendix.

What does acute appendicitis look like under a microscope?

When your pathologist examines your appendix under a microscope, he will look for specialized immune cells called neutrophils in the wall of your appendix. These neutrophils often combine with bacteria to form an abscess (pus). Neutrophils can also be seen on the outer surface of the appendix. Pathologists describe it as periappendicitis.

Observations and tips of this article we have prepared based on the experience of the team, the inflammation observed in acute appendicitis begins on the inside of the appendix, but spreads rapidly, affecting the wall and even the outer part of the appendix. The appendix can also swell, which blocks blood from getting in and out of the appendix. When this happens, parts of the appendix may begin to die due to a process called necrosis.

Acute appendicitis. This low magnification microscopic image shows an appendix with signs of acute appendicitis.

What does perforated appendicitis mean?

If left untreated, a hole or perforation may form in the appendix, and material inside the appendix may enter the abdominal cavity. This release can cause an abscess to form around the appendix.

What does periappendicitis mean?

Periappendicitis refers to inflammation on the outer surface of the appendix. Periappendicitis is a very common finding in acute appendicitis.

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clinical case, patient history of the clinic JSC “Medicina” in Moscow

Surgeon, coloproctologist, oncologist

Skorkina

Irina Konstantinovna

Experience 16 years

Doctor of the highest category, member of the European Society of Surgeons

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Patient S., 45 years old.

Complaints on admission:

pulling pains in the lower abdomen;

nausea;

bloating.

Medical history.

I was sick during the day, when there was pain in the lumbar region, discomfort in the epigastric region, pain in the left hypochondrium.

The ambulance team diagnosed intercostal neuralgia, introduced “Tramadol”, “Baralgin” and “Platifillin” – the pain syndrome was stopped.

On the day of admission, there was pain in the lower abdomen, bloating, fever up to 37.5°C. Notes similar bouts of pain before.

Anamnesis of life.

Chronic calculous cholecystitis.

Chronic iron deficiency anemia against the background of polymenorrhea for several years.

Objectively.

The condition is satisfactory. Skin and mucous membranes of normal color. Pulse 96 beats per minute, rhythmic, good filling. Respiratory rate 18 per minute. Body temperature 37.4°C. Breathing is vesicular, no wheezing. Tongue dry, covered with white coating. The abdomen is swollen, soft, moderately painful above the womb, in the mesogastric region. There are no peritoneal symptoms. Peristalsis is uniform, there are no pathological intestinal noises. Appendicular symptoms are negative. There is no dysuria. The symptom of tapping is negative on both sides. The chair is decorated, regular.

Instrumental and laboratory research.

Chest X-ray – no pathology.

Ultrasound of the abdominal organs – Echo-signs of diffuse changes in the liver (like fatty hepatosis) and pancreas, chronic calculous cholecystitis.

Ultrasound of the pelvic organs – Echo-signs of endometriosis of the uterine body, endocervix cysts, ovarian cysts (endometrioid?), The minimum amount of free fluid in the pelvic cavity.

Complete blood count – hemoglobin 105 g / l, leukocytes – 7.38 × 10 ⁹ g/l, stab – 4%, ESR – 16 mm/h.

Urinalysis – unchanged erythrocytes – 9 in p / sp.

Dynamic observation.

A state without dynamics – pain in the abdomen, more in the left hypochondrium, an increase in body temperature up to 38 ° C. Tongue dry, covered with white coating. The abdomen is swollen, moderately painful above the bosom. There was tension in the muscles of the anterior abdominal wall in the right iliac region. There are no peritoneal symptoms.

Increasing blood leukocytosis from 7×10 ⁹
up to 9×10 ⁹ , stab – from 4 to 8%.

Gynecological consultation.

Apoplexy of a cyst of the left ovary is suspected.

Additional diagnostics.

A CT scan of the abdominal organs was performed – CT signs of calculous cholecystitis.

Moderate signs of lipoid infiltration of the liver.

Indirect signs of pancreatitis.

Differential diagnostic series.

Acute appendicitis.

Apoplexy of a cyst of the left ovary.

Acute cholecystopancreatitis.

Acute appendicitis?

Apoplexy of a cyst of the left ovary.

Acute cholecystopancreatitis.

Indications for surgery – diagnostic laparoscopy.

Impossibility of establishment of the diagnosis by other methods.

The need for emergency intervention in confirming the diagnosis of acute appendicitis.

Progression of symptoms on the background of infusion, detoxification and antibiotic therapy.

The appearance of signs of tension in the right iliac region.

Diagnostic laparoscopy.

Under the ETN, after processing the surgical field, a 10 mm laparoscope was inserted through the umbilical ring. Insufflation CO ₂ . During the revision: in the small pelvis and between the loops of the small intestine, traces of lysed blood were drained. In the right iliac fossa, a loose infiltrate is determined, consisting of the dome of the caecum and the appendix, the latter is destructively changed and fixed to the parietal peritoneum. The infiltrate is divided, the appendix is ​​highlighted to the base. The mesentery was cut off using bipolar coagulation.