Appendicitis: A critical reappraisal of symptoms and signs

Abstract

Objective: To identify the symptoms and signs predictive of appendicitis in patients with abdominal pain. Materials and Methods: We present a case of acute abdomen in a 25-year-old male patient with symptoms suggestive of appendicitis. An evaluation of the operating characteristics of the most useful elements of the history and physical examination for the diagnosis of appendicitis, and a literature review of the predictive symptoms and signs of appendicitis, are presented. Results: The presence of a positive psoas sign, fever and migratory pain to the right iliac quadrant suggests an increased likelihood of appendicitis. Conversely, the presence of vomiting before abdominal pain makes appendicitis unlikely. The lack of the classical migration of pain, right lower quadrant pain, guarding or fever makes appendicitis less likely. Conclusion: A rapid and accurate clinical diagnosis must be made when the patient presents with a questionable acute appendicitis. Once the diagnosis is confirmed to a reasonable degree of certainty, surgical intervention is indicated.

Keywords

• acute appendicitis
• pathophysiology
• diagnosis