Advancing appendicitis care: A comprehensive review of epidemiology, pathogenesis, and evolving treatment strategies

Abstract

Appendicitis is the inflammation of the vermiform appendix and constitutes a significant global health challenge. Traditionally addressed through surgical intervention, the disease's complexity is now better understood, involving a wider array of both surgical and non-surgical management strategies. This review provides a detailed examination of appendicitis from its epidemiological distribution to its pathophysiological underpinnings, clinical presentation, diagnostic modalities, and treatment approaches. The global incidence of appendicitis suggests demographic and geographic disparities, with the highest prevalence among the younger population. Developed countries are witnessing a decline in incidence, attributed to dietary and hygienic improvements, whereas the trend is static or rising in developing regions, compounded by healthcare accessibility issues. Seasonal patterns and gender predilections are noted, with lifestyle factors like diet playing a possible role in prevention. Appendicitis generally begins with an obstruction of the appendiceal lumen, leading to bacterial proliferation, increased pressure, venous outflow impairment, ischemia, and potential perforation. This progression from a simple inflammation to a complex infection underscores the importance of early diagnosis and management. Immunological and genetic Appendicitis is the inflammation of the vermiform appendix and constitutes a significant global health challenge. factors appear to modulate individual susceptibility and disease course, marking an area of active research. The symptomatology of appendicitis is varied, often characterized by a shift of pain from the umbilical region to the lower right abdomen. Diagnostic strategies encompass clinical scoring systems like the Alvarado score, supplemented by laboratory and imaging investigations, with CT scans being particularly diagnostic. While appendectomy remains the definitive treatment, the emergence of non-operative management (NOM) with antibiotics represents a paradigm shift for uncomplicated cases. Complex cases may necessitate an interval appendectomy or percutaneous drainage, with treatment individualized to patient response and health status. Appendicitis, once considered a straightforward surgical condition, is now recognized as a complex interplay of epidemiological, pathophysiological, and clinical factors. This review encapsulates the evolving understanding and approaches, emphasizing the necessity of tailored management strategies to enhance patient outcomes.