A common presentation of appendiceal inflammation. Inflammation can result in infection, thrombosis, necrosis, and perforation or rupture of the intestine. Peritonitis (inflammation of the peritoneal cavity) may follow, as the contents of the lower gastrointestinal tract enter the abdominal cavity. Classic presentations, which occur about 60% of the time, include abdominal pain (initially diffuse, gradually localizing to the right lower quadrant), loss of appetite, nausea, fever, and an elevated white blood cell count. The disease is more common in males and generally occurs in the young, usually between the ages of 10 and 20, but rarely before age 2 and less often after age 50. It is nevertheless important in the differential diagnosis of abdominal pain in older adults.
In this type the patient suffers with pain of acute onset in the lower right-hand corner of the abdomen known as the right hypogastrium or right iliac fossa. Occasionally, however, the pain starts in the region of the navel before settling in the right iliac fossa. Vomiting often occurs after the onset of pain, and the patient has some degree of rising temperature, a rapid pulse, often a coated tongue, and tenderness to touch over the appendix area. The muscles over the appendix may go into protective spasm and supply the sign called abdominal rigidity. The importance of recognizing these symptoms as a possible case of acute appendicitis cannot be overemphasized because some mothers give purgatives to relieve abdominal pain. If this is done there is a grave risk of bursting the appendix and converting a straightforward case of appendicitis, requiring a relatively simple surgical operation to remove the inflamed appendix, into a case of acute peritonitis. This has a much graver significance, requiring drainage of the abdominal cavity.