What Patients Will Have an “Atypical” Presentation for Appendicitis? What Are Those Presentations?

Abstract

Appendicitis presents with classic symptoms (migratory pain, nausea, vomiting, anorexia, and fever) only about half the time. Variable lie of the appendix can result in atypical symptoms, including diarrhea and dysuria, as different structures become inflamed. Patients with atypical anatomy, including pregnant patients, may develop pain in unusual locations, including the right upper quadrant. Pregnant patients may lack the classic pain presentation due to downregulation of pain receptors and increased distance between the appendix and parietal peritoneum. Pediatric patients may present with various nonspecific signs and symptoms, including irritability and hip pain/limping. Elderly patients present classically only a quarter of the time; they often present later in the disease process and more frequently present with perforation. Thus, they more frequently have generalized pain and/or peritoneal signs upon presentation. Pregnant patients and diabetics also present with perforation more frequently than the general population.