APPENDICITIS History Berengario DaCarpi, a physician-anatomist,
made the first description of the appendix in 1521 Leonardo DaVinci
demonstrated the appendix in drawings made in 1492 but not
published until the 18th century. Lorenz Heister gave the first
unequivocal account of appendicitis in 1711 The appendix is clearly
illustrated in De Humani Corporis Febrica Liber V by Andreas
Vesalius published in 1543 Vesalius A. De Humani Corporis Fabrica
Liber V. Basel: Iohannis Oporini; 1543.
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APPENDICITIS History Heister, a student of Boerhaave, described
a perforation of the appendix with a small abscess adjacent to a
gangrenous appendix Heister speculated that the appendix might be
the site of acute inflammation. He described the autopsy on the
body of a criminal Francois Melier, a Parisian physician, described
6 cases of appendicitis at autopsy and first suggested the
possibility of removing the appendix in 1827
Slide 4
APPENDICITIS History Claudius Amyand, Sergeant Surgeon to
George II, performed the first known appendectomy in 1735. He
operated on an 11-year-old boy with a right scrotal hernia and a
fistula. He identified the appendix, perforated by a pin, within
the scrotum. He ligated the appendix and removed it. Shepherd JA.
Acute appendicitis: a historical survey. Lancet
1954;2:299-302.
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APPENDICITIS History Fitz 1886 Proposed that the appendix is
the cause of most inflammatory disease of the right lower quadrant.
He went on to describe the clinical features of appendicitis and,
importantly, proposed early surgical removal of the appendix Fitz
RH. Perforating inflammation of the vermiform appendix: with
special reference to its early diagnosis and treatment. Am J Med
Sci 1886;92:321-46.
Slide 6
APPENDICITIS History In 1889, McBurney of New York published
the first of several important papers regarding the appendix. He
suggested early operative intervention and developed the
muscle-splitting incision that bears his name and is commonly used
today McBurney C. Experience with early operative interference in
cases of disease of the vermiform appendix. NY Med J
1889;50:676-84. McBurney C. The incision made in the abdominal wall
in cases of appendicitis, with a description of a new method of
operation. Ann Surg 1894;20:38-43.
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APPENDICITIS Introduction Lifetime risk 6% to 7% Peak age
Adolescents and young adults Uncommon 50 yrs 1 in 35 men 1 in 50
women Male:Female 1.3:1
Slide 8
APPENDICITIS Introduction More common in industrialised nations
(refined, low fibre diet) Presumably, this diet leads to hard
stool, higher intracolic pressure and faecolith formation Familial
association is simply due to similar environment and dietary
habits
Slide 9
APPENDICITIS Pathophysiology Small lumen to length ratio
Predisposed to closed loop obstruction, especially with proximal
swelling or faecolith Ongoing mucosal secretion leads to elevated
intraluminal pressure Venous pressure is exceeded and ischaemia
develops Hypoxic mucosa begins to ulcerate Bacterial
translocation
Slide 10
Slide 11
APPENDICITIS Clinical Features Begins as peri-umbilical
discomfort poorly localised and unrelieved by stools. Loss of
Appetite (80%) Nausea (+- vomiting) Diarrhoea (uncommon) 6-12 hours
later localised to RIF (localised peritonism) Less tenderness in
retrocaecal or pelvic appendix Pyrexia (37.5 to 38) 25% to 50% have
temp