HISTORY OF APPENDICITIS

The natural history of appendicitis varies slightly in the elderly and early life, as well as during pregnancy. Recognition of this is key to accurate diagnosis and treatment of this common but potentially fatal medical condition.

We shall give a brief history of this disease here, and then highlight the natural history of acute appendicitis in the very young, adult, and elderly.

Even though the word appendicitis was already in use in 1885 when the Oxford English Dictionary was first publish, it was not until 1902 after the king of England, Edward VII had his appendix removed that the term came to be acceptable and widely used.

Reginald Fitz in 1886 presented a paper to the American Association of Physicians where he describes the first recorded case of appendicitis.

Later, Dr Charles Mc Burney described in details the constellation of signs and symptoms that characterizes appendicitis, as well as map out the spot where maximum pain is felt by patients suffering from this disease – the Mc Burney’s point, which is the junction of the outer third of a line drawn from the navel to the anterior superior iliac crest (tip of the waist bone).

Appendicitis is so common today, that it is the greatest cause of acute abdominal admissions worldwide.

CLASSICAL HISTORY OF APPENDICITIS

The classic history is that of a dull to severe right side abdominal pain that may have commenced around the umbilicus and moved over the course of 30 minutes to 24 hours to the right lower abdomen, called right iliac fossa.

The pain may be accompanied by fever, nausea, and vomiting.It is important to note that the most common symptom associated with appendicitis pain is anorexia, or loss of appetite. Vomiting after the onset of pain is also classical.

APPENDICITIS IN THE VERY YOUNG

Appendicitis has been reported within the first 28 days of life. Such new born babies obviously can not complain of pain. They often become unwell, and may refuse their feeds, showing non-specific signs and symptoms. They may or may not run temperature.

A careful examination of the newborn to rule out all other cause of illness in this age group may help to point to the appendix as the cause of trouble. Thankfully, appendicitis in newborn is extremely rare.If diagnosed, surgical operation is still the cure.

For older children, they may be able to localize pain to the tummy, and where such child can speak, he or she may give a reasonable history of appendicitis.

APPENDICITIS IN THE ELDERLY

History of appendicitis in the elderly is more or less like would be expected in a young adult, but with the absence of fever on most occasions.

There may be associated diarrhoea or constipation, with loss of appetite.

APPENDICITIS IN PREGNANCY

Appendicitis and pregnancy could go together. Depending on the stage of pregnancy, the history will be the same, but the position of the pain may be higher on the right side of the abdomen than is normally expected.

The next section discusses what could cause appendicitis.