Appendicitis: Classic Presentation, Atypical Variants, and Urgency of Care

Appendicitis is a surgical emergency. Classic evolution:

1. Periumbilical visceral pain (T10 referral) – 4–6 h.
2. Migration to RLQ (McBurney’s point) – somatic parietal peritoneal irritation.
3. Anorexia, nausea ± vomiting – almost universal.
4. Low‑grade fever (37.5–38.5 °C).
5. RLQ tenderness, guarding, rebound – Rovsing’s, psoas, obturator signs.

Atypical Presentations

• Pelvic appendix → suprapubic/rectal pain, urinary symptoms.
• Retrocecal → flank pain, less anterior tenderness.
• Pregnancy → RUQ/RLQ shift; diagnosis delayed.
• Elderly/immunocompromised → muted symptoms, higher perforation risk.

Complications of Delay

• Perforation → peritonitis, abscess, sepsis.
• Fertility impact (tubal scarring) in females.

Action

RLQ pain + anorexia + fever = surgical consult NOW. CT (adults) or US (kids/pregnant) confirms; laparoscopic appendectomy is standard.