Acute appendicitis.

Acute appendicitis is inflammation of the vermiform appendix. It is the most common general surgical emergency in children and young adults, yet its diagnosis can still confound the most skilled surgeon. This difficulty arises because the presentation of appendicitis is highly variable, with less than 50% of patients exhibiting classical features. Taking a detailed history and performing a careful examination remains the cornerstone of diagnosis. Urinalysis and blood test, particularly CRP are useful adjuncts and are performed routinely. Radiological imaging, commonly US and CT scans, also have a role when the diagnosis is unclear and/or other common conditions need to be excluded such as gynaecological pathology in young females. Nevertheless, 20% of appendices removed in UK are histologically normal. Appendicitis scoring systems may further assist in stratifying risk and increasing the accuracy of diagnosis. Recently, there has been growing interest in non-surgical management of appendicitis. Antibiotics alone have been used to successfully treat uncomplicated appendicitis, i.e. without perforation, abscess or gangrene, thereby potentially avoiding the risks of surgery. However, nearly 40% of these cases eventually require appendicectomy. Therefore surgery, usually laparoscopic appendicectomy, remains the treatment of choice for acute appendicitis and non-operative management is reserved for specific cases. [ABSTRACT FROM AUTHOR]