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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

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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.

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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

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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

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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

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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