appendectomy

Appendectomy is indicated primarily for acute appendicitis, which results from luminal obstruction (often by a fecalith, lymphoid hyperplasia, or rarely a tumor) leading to bacterial overgrowth, inflammation, distension, and risk of perforation if untreated. Clinical presentation classically includes periumbilical pain migrating to McBurney's point (RLQ), fever, anorexia, nausea, and rebound tenderness/guarding. Diagnosis is supported by clinical scoring systems (e.g., Alvarado score), elevated WBC count, and imaging (CT abdomen/pelvis is gold standard in adults; ultrasound preferred in children and pregnant women). Laparoscopic appendectomy is now standard of care in uncomplicated cases, offering reduced pain, shorter hospital stay, and fewer wound infections compared to open surgery, though open approach may be necessary in cases of perforation, abscess, or dense adhesions. Complications of untreated appendicitis include perforation, peritonitis, and abscess formation. Postoperative complications include wound infection, intra-abdominal abscess, and rarely stump appendicitis. Histopathology of the removed appendix should always be reviewed, as incidental findings such as carcinoid tumors or mucinous neoplasms can occur. In some cases of uncomplicated appendicitis, antibiotic therapy alone has been studied as an alternative to surgery, though appendectomy remains the definitive treatment to prevent recurrence and complications.