In the Panel Session, “Not Your Usual Appendicitis: Managing the Inflamed Appendix in Unusual Situations,” on Monday morning, October 6, panelists will outline up-to-date clinical studies that describe management protocols for divergent presentations of acute appendicitis.
Appendicitis is one of the most common surgical emergencies worldwide, with more than 250,000 cases in the US annually. Uncommon presentations of the disease, which occur in 20%–30% of cases, can lead to challenging clinical scenarios regarding diagnoses and treatment as these patients may not exhibit the classic symptoms associated with this condition.
“These cases may present with unusual symptoms, such as diffuse or minimal abdominal pain, or symptoms that mimic other conditions like gastroenteritis, urinary tract infections, or gynecologic issues,” explained comoderator Rebecca C. Britt MD, FACS, chief of surgery at Sentara Norfolk General Hospital in Virginia. “Atypical presentations are more frequent in certain groups, including young children, older adults, and pregnant patients, where anatomy or physiology may alter classic signs. Additionally, complicated appendicitis—such as cases involving a phlegmon, abscess, or appendiceal mass—can also present atypically. Because of this variability, atypical appendicitis often leads to delayed diagnosis and treatment, increasing the risk of complications.”
Specifically, presenters will explore:
- Managing the appendix in the setting of inflammatory bowel disease of the distal ileum and cecum
- Evaluating and managing incidental appendiceal mass
- Managing options for appendicitis presenting with a phlegmon
- Treating acute appendicitis presenting as an inguinal hernia
- Describing the role of interval appendectomy after nonoperative management of complicated appendicitis
“These forms of appendicitis are difficult to manage because they often present atypically or occur in complex clinical settings,” Dr. Britt said. “Inflammatory bowel disease can obscure the diagnosis and increase surgical risks due to overlapping symptoms and inflamed tissues. A phlegmon or abscess complicates decision-making as immediate surgery may cause harm, but delayed treatment risks disease progression. Rare presentations like Amyand’s hernia or appendiceal masses can lead to missed or delayed diagnoses, requiring specialized surgical approaches. And finally, the decision about whether to perform interval appendectomy after nonoperative management continues to be controversial, making long-term care planning challenging.”
Dr. Britt said she anticipates that session attendees will return to their daily practices with clinical strategies to help avoid delayed or missed diagnoses of atypical cases of acute appendicitis.
