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

  • Stephen D. LeeEmail author


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.


Appendicitis Atypical Presentation Pediatric Elderly Pregnant Diabetic 


  1. 1.
    Humes D, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530–4.CrossRefGoogle Scholar
  2. 2.
    Petroianu A. Invited review: diagnosis of acute appendicitis. Int J Surg. 2012;10(3):115–9.CrossRefGoogle Scholar
  3. 3.
    Puskar D, Bedalov G, Fridrih S, et al. Urinalysis, ultrasound analysis, and renal dynamic scintigraphy in acute appendicitis. Urology. 1995;45:108–12.CrossRefGoogle Scholar
  4. 4.
    Humes DJ, Simpson J. Clinical presentation of acute appendicitis: clinical signs—laboratory findings—clinical scores, Alvarado score and derivate scores. In: Keyzer C, Gevenois P, editors. Imaging of acute appendicitis in adults and children. Medical radiology. Berlin/Heidelberg: Springer; 2012.Google Scholar
  5. 5.
    Wei C, Chang C, Lee C, Chen J, Yin W. Acute appendicitis in organ transplantation patients: a report of two cases and a literature review. Ann Transplant. 2014;19:248–52.CrossRefGoogle Scholar
  6. 6.
    Flexer S, Tabib N, Peter M. Review: suspected appendicitis in pregnancy. Surgeon. 2014;12(2):82–6.CrossRefGoogle Scholar
  7. 7.
    Franca Neto AH, Amorim MM, Nóbrega BM. Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras (1992). 2015;61(2):170–7.CrossRefGoogle Scholar
  8. 8.
    Bouyou J, Gaujoux S, Marcellin L, Leconte M, Goffinet F, Chapron C, Dousset B. Review: abdominal emergencies during pregnancy. J Visc Surg. 2015;152(6 Suppl):S105–15.CrossRefGoogle Scholar
  9. 9.
    Sinclair J, Marzalik P. Suspected appendicitis in the pregnant patient. J Obstet Gynecol Neonatal Nurs. 2009;38(6):723–9.CrossRefGoogle Scholar
  10. 10.
    Rothrock S, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000;36(1):39–51.CrossRefGoogle Scholar
  11. 11.
    Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med. 2007;14(2):124–9.CrossRefGoogle Scholar
  12. 12.
    Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2017;24(5):523–51.CrossRefGoogle Scholar
  13. 13.
    Glass C, Rangel S. Overview and diagnosis of acute appendicitis in children. Semin Pediatr Surg. 2016;25(4):198–203.CrossRefGoogle Scholar
  14. 14.
    Storm-Dickerson T, Horattas M. What have we learned over the past 20 years about appendicitis in the elderly? Am J Surg. 2003;185(3):198–201.CrossRefGoogle Scholar
  15. 15.
    Segev L, Keidar A, Schrier I, Rayman S, Wasserberg N, Sadot E. Acute appendicitis in the elderly in the twenty-first century. J Gastrointest Surg. 2015;19(4):730–5.CrossRefGoogle Scholar
  16. 16.
    Bach L, Donovan A, Loggins W, Thompson S, Richmond B. Appendicitis in diabetics: predictors of complications and their incidence. Am Surg. 2016;82(8):753–8.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreUSA

Personalised recommendations