Acute Appendicitis

 Differential diagnosis is a
process of differentiating
between two or more
condition sharing similar
signs and symptoms
*This image is taken from Bailey and love 28th edition
 Meckel’s Diverticulum present clinically like acute appendicitis. It
is not possible to differentiate between two clinically. CT held in
differentiating between two.
 Intussusception mimics acute appendicitis in children. ISS is
common before age of 2 years. Acute appendicitis is rare before
the age of 2 years. Palpable mass, features of intestinal
obstruction, barium enema X-ray, US are useful methods to
differentiate.
 Mesenteric adenitis is difficult to differentiate from acute
appendicitis. It is treated conservatively. CT may be helpful to
identify it. The cervical lymph node may be enlarged and can
show symptoms like Diarrhea.
 Perforated Duodenal ulcer : In duodenal ulcer perforation,
fluid trickles down along right paracolic gutter and mimics
appendicitis. Gas under diaphragm in X-ray and CT scan
differentiate it from acute appendicitis.
 Right ureteric colic: Pain is colicky in nature which often
refers to genitalia. Hematuria, urinary symptoms are
common. It mimics pelvic acute appendicitis. CT is the
important way to differentiate.
 Pelvic inflammatory disease like salpingo-oophhoritis mimics
acute appendicitis. Twisted/haemorrhagic/ruptured ovarian
cyst mimics acute appendicitis. US, laparoscopy helps to
differentiate from others.
 The diagnosis of acute appendicitis is
essentially clinical
 However, the decision to operate based on
clinical suspicion alone can lead to the
removal of a normal appendix in 15-30% of
cases.
 A number of clinical and laboratory based
scoring system have been devised to assist
diagnosis.
 The most widely used is the Alvarado Score.
 Score >7 (strong
predictive of acute
appendicitis)
 Score 5 or 6
(further radiological
investigation has to
be performed)
Conventional radiograph
shows a calcified
appendicolith