Surgery pp 991-1010 | Cite as


  • David Soybel


The vermiform appendix was recognized as an independent anatomical structure at the beginning of the 16th century.1, 2, 3 The appendix was sketched in the anatomical notebooks of Leonardo Da Vinci (Fig. 50.1; ca. 1500) and was called an “orecchio” or ear. However, it appears to have been formally described in 1524 by Da Capri4 and in 1543 by Vesalius.5 In 1554, Fernel6 described a case of a 7-year-old girl who was given a large quince as a remedy for diarrhea. The girl subsequently developed severe abdominal pain and ultimately died. At autopsy, the quince was found to have adhered to and obstructed the lumen of the appendix; the appendix had become necrotic and perforated. Until the 18th century, cases of appendicitis were described at autopsy.1, 2, 3 Amy and is credited with the first recorded appendectomy (1736), performed when a boy presented with a fistula in a hernia.7 Exploring the hernia, Amyand found the appendix in the scrotal sac. A calcified mass and fecal fistula had formed around the wall of the appendix where it had been perforated by a pin. Subsequently, in the mid-1800s, a number of cases of appendiceal abscess were recognized before death. Some were drained, with recovery of the patients.1, 2, 3


Acute Appendicitis Carcinoid Tumor Acute Abdominal Pain Open Appendectomy Parietal Peritoneum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Williams RA, Myers P. Pathology of the Appendix. London: Chapman & Hall; 1994:1–7.Google Scholar
  2. 2.
    Meade RH. In: An Introduction to the History of General Surgery. Philadelphia: Saunders; 1968:291–304.Google Scholar
  3. 3.
    Richardson RG. The Surgeon’s Tale. New York: Scribner’s; 1958.Google Scholar
  4. 4.
    Da Capri JB. Commentaria cum Amplissimus Additionibus Super Anatomia Mundini Una cum Texta Ejusudem in Pristinum et Verum Nitorem Redanto [quoted in ref. 3]. Bolonial Imp. per H. Benedictus; 1521: 528 ff.Google Scholar
  5. 5.
    Vesalius A. Liber V. In: De Humani Corporis Fabrica. Basel: Johanes Oporinu; 1543:361–362.Google Scholar
  6. 6.
    Fernal JQiTC. In: Classic Description of Disease. Universa Medicina Springfield, 1932:614–615.Google Scholar
  7. 7.
    Amyand C. Of an inguinal rupture, with a pin in the appendix coeci, incrusted with stone, and some observations on wounds in the guts. Phil Trans R Soc Lond 1736;39:329–342.Google Scholar
  8. 8.
    Tait L. Surgical treatment of typhlitis. Birmingham Med Rev 1890;27:26–34.Google Scholar
  9. 9.
    Fitz RH. Perforating inflammation of the vermiform appendix; with special reference to its early diagnosis and treatment. Am J Med Sci 1886;92:321–346.Google Scholar
  10. 10.
    McBurney CM. Experience with early operative interference in cases of disease of the vermiform appendix. N Y Med J 1889;50:676–684.Google Scholar
  11. 11.
    Kelly HA, Hurdon E. In: Anatomy of the Vermiform Appendix and Its Diseases. Philadelphia: Saunders; 1905:55–74.Google Scholar
  12. 12.
    Myers S, Miller TA. Acute abdominal pain: physiology of the acute abdomen. In: Miller TA, ed. The Physiological Basis of Modern Surgical Care. St. Louis: Quality Medical; 1998:641–667.Google Scholar
  13. 13.
    Dhillon AP, Rode J. Serotonin and its possible role in the painful non-inflamed appendix. Diagn Histopathol 1983;6:239–246.PubMedGoogle Scholar
  14. 14.
    Dhillon AP, Williams RA, Rode J. Age, site, and distribution of subepithelial neurosecretory cells in the appendix. Pathology 1992;24:56–59.PubMedGoogle Scholar
  15. 15.
    Rode J, et al., Neurosecretory cells of the lamina propria of the appendix, and their possible relationship to carcinoids. Histopathology 1982;6:69–73.PubMedGoogle Scholar
  16. 16.
    Bockman DE, Cooper MD. Early lymphoepithelial relationships in human appendix. Gastroenterology 1975;68:1160–1168.PubMedGoogle Scholar
  17. 17.
    Spencer J, Finn T, Isaacson PG. Gut-associated lymphoid tissue: a morphological and immunocytochemical study of the human appendix. Gut 1985;26:672–679.PubMedGoogle Scholar
  18. 18.
    Wangensteen OH, et al. Studies in the etiology of acute appendicitis: the significance of the structure and function of the vermiform appendix in the genesis of appendicitis. Ann Surg 1937;106:910–942.PubMedGoogle Scholar
  19. 19.
    Wangensteen OH, Dennis C. Experimental proof of the obstructive origin of appendicitis in man. Ann Surg 1939;119:629–647.Google Scholar
  20. 20.
    Burkitt DP. The aetiology of appendicitis. Br J Surg 1971;58:695–699.PubMedGoogle Scholar
  21. 21.
    Jones BA, et al. The prevalence of appendiceal fecaliths in patients with and without appendicitis. A comparative study from Canada and South Africa. Ann Surg 1985;202:80–82.PubMedGoogle Scholar
  22. 22.
    Peck JJ. Management of carcinoma discovered unexpectedly at operation for acute appendicitis. Am J Surg 1988;155:683–685.PubMedGoogle Scholar
  23. 23.
    Armstrong CP, et al., Appendicectomy and carcinoma of the cecum. Br J Surg 1989;76:1049–1053.PubMedGoogle Scholar
  24. 24.
    Klingler PJ, et al. Management of ingested foreign bodies within the appendix: a case report with review of the literature. Am J Gastroenterol 1997;92:2295–2298.PubMedGoogle Scholar
  25. 25.
    Pieper R, Kager L, Tidefeldt U. Obstruction of appendix vermiformis causing acute appendicitis. Acta Chir Scand 1982;148:63–72.PubMedGoogle Scholar
  26. 26.
    Sisson RG, Ahlvin RC, Hartlow MC. Superficial mucosal ulceration and the pathogenesis of acute appendicitis in childhood. Am J Surg 1971;122:378–380.PubMedGoogle Scholar
  27. 27.
    Nitecki S, Karmeli R, Sarr MG. Appendiceal calculi and fecaliths as indications for appendectomy. Surg Gynecol Obstet 1990;171:185–188.PubMedGoogle Scholar
  28. 28.
    Arnbjornsson E, Bengmark S. Role of obstruction in pathogenesis of acute appendicitis. Acta Chir Scand 1983;149:789–791.PubMedGoogle Scholar
  29. 29.
    Arnbjornsson E, Bengmark S. Role of obstruction in pathogenesis of acute appendicitis. Am J Surg 1984;147:390–392.PubMedGoogle Scholar
  30. 30.
    Thadepalli H, et al. Bacteriology of the appendix and the ileum in health and in appendicitis. Am Surg 1991;57:317–322.PubMedGoogle Scholar
  31. 31.
    Pieper R, et al. The role of Bacteioides fragilis in acute appendicitis. Acta Chir Scand 1982;148:39–44.PubMedGoogle Scholar
  32. 32.
    Bennion RS, et al. The bacteriology of gangrenous and perforated appendicitis—revisited. Ann Surg 1990;211:165–171.PubMedGoogle Scholar
  33. 33.
    Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults: a prospective study. Ann Surg 1995;221:278–281.PubMedGoogle Scholar
  34. 34.
    Saxena R, et al. Pylephlebitis: a case report and review of outcome in the antibiotic era. Am J Gastroenterol 1996;91:1251–1253.PubMedGoogle Scholar
  35. 35.
    Baril N, et al. The role of anticoagulation in pylephlebitis. Am J Surg 1996;172:449–452.PubMedGoogle Scholar
  36. 36.
    Ramsden WH, et al. Is the appendix where you think it is—and if not does it matter? Clin Radiol 1993;47:100–103.PubMedGoogle Scholar
  37. 37.
    Karim OM, Boothroyd AE, Wyllie JH. McBurney’s point—fact or fiction? Ann R Coll Surg 1990;72:304–308.Google Scholar
  38. 38.
    Guidry SP, Poole GV. The anatomy of appendicitis. Am Surg 1994;60:68–71.PubMedGoogle Scholar
  39. 39.
    Shen GK, et al. Does the retrocecal position of the vermiform appendix alter the clinical course of acute appendicitis? A prospective analysis. Arch Surg 1991;126:569–570.PubMedGoogle Scholar
  40. 40.
    Dixon JM, et al. Rectal examination in patients with pain in the right lower quadrant of the abdomen. Br Med J 1991;302:386–388.Google Scholar
  41. 41.
    Thompson MM, et al. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Br J Surg 1992;79:822–824.PubMedGoogle Scholar
  42. 42.
    Scott JH, Amin M, Harty JI. Abnormal urinalysis in appendicitis. J Urol 1983;129:1015–1018.PubMedGoogle Scholar
  43. 43.
    Puskar D, et al. Urinalysis ultrasound analysis, and renal dynamic scintigraphy in acute appendicitis. Urology 1995;45:108–112.PubMedGoogle Scholar
  44. 44.
    Swensson EE, Maull KI. Clinical significance of elevated serum and urine amylase levels in patients with appendicitis. Am J Surg 1981;142:667–670.PubMedGoogle Scholar
  45. 45.
    Gumaste W, et al. Serum lipase levels in non-pancreatic abdominal pain. Am J Gastroenterol 1993;88:2051–2055.PubMedGoogle Scholar
  46. 46.
    Balthazar EJ, et al. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994;190:31–35.PubMedGoogle Scholar
  47. 47.
    Balthazar EJ, et al. Appendicitis: prospective evaluation with high resolution CT. Radiology 1991;180:21–24.PubMedGoogle Scholar
  48. 48.
    Rao PM, et al. Effect of computerized tomography of the appendix on treatment of patients and use of hospital resources. New Engl J Med 1998(338):141–146.Google Scholar
  49. 49.
    Korner H, et al. Structured data collection improves the diagnosis of appendicitis. Br J Surg 1998;85:341–344.PubMedGoogle Scholar
  50. 50.
    Cullen JJ, et al. Surgical management of Meckel’s diverticulum: an epidemiologic, population-based study. Ann Surg 1994;220:564–568.PubMedGoogle Scholar
  51. 51.
    Harada RN, Whelan TJ. Surgical management of cecal diverticulitis. Am J Surg 1993;166:666–669.PubMedGoogle Scholar
  52. 52.
    Soybel DI, Bliss DP, Wells SA. Colorectal carcinoma. Curr Probl Cancer 1987;11:259–356.Google Scholar
  53. 53.
    Bizer LS. Acute appendicitis is rarely the presentation of cecal cancer in the elderly patients. J Surg Oncol 1993;54:45–46.PubMedGoogle Scholar
  54. 54.
    Singh KK, et al. Presentation of endometriosis to general surgeons: a 10 year experience. Br J Surg 1995;82:1349–1351.PubMedGoogle Scholar
  55. 55.
    Arnbjornsson E. Influence of oral contraceptives on the frequency of acute appendicitis in different phases of the menstrual cycle. Surg Gynecol Obstet 1984;158:464–466.PubMedGoogle Scholar
  56. 56.
    Graff L, Radford MJ, Werne C. Probability of appendicitis before and after observation. Ann Emerg Med 1991;20:503–507.PubMedGoogle Scholar
  57. 57.
    Campbell JP, Gunn AA. Plain abdominal radiographs and acute abdominal pain. Br J Surg 1988;75:554–556.PubMedGoogle Scholar
  58. 58.
    Jeffrey RBJ, Federle MP, Tolentino CS. Periappendiceal inflammatory masses: CT-directed management and clinical outcome in 70 patients. Radiology 1988;167:13–16.PubMedGoogle Scholar
  59. 59.
    Hurme T, Nylamo E. Conservative versus operative treatment of appendicular abscess. Experience of 147 consecutive patients. Ann Chir Gynaecol 1995;84:33–36.PubMedGoogle Scholar
  60. 60.
    Gee D, Babineau TJ. The optimal management of adult patients presenting with appendiceal abscess: “conservative” versus immediate operative management. Curr Surg 2004;61:524–528.PubMedGoogle Scholar
  61. 61.
    Eriksson S, Granstrom L. Randomized controlled trial of appendectomy versus antibiotic therapy for acute appendicitis. Br J Surg 1995;82:166–169.PubMedGoogle Scholar
  62. 62.
    Winn RD, et al. Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics. Aust N Z J Surg 2004;74:324–329.Google Scholar
  63. 63.
    Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:1048–1049.Google Scholar
  64. 64.
    Douglas CD, et al. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. Br Med J 2000;321:919–922.Google Scholar
  65. 65.
    Nichols RL. Surgical antibiotic prophylaxis. Surg Clin North Am 1995;79:509–522.Google Scholar
  66. 66.
    McCahill LE, et al. A clinical outcome and cost-analysis of laparoscopic versus open appendectomy. Am J Surg 1996;171:533–537.PubMedGoogle Scholar
  67. 67.
    McCall JL, Sharpies K, Jadallah F. Systematic review of randomized controlled trials comparing laparoscopic with open appendectomy. Br J Surg 1997;84:1045–1050.PubMedGoogle Scholar
  68. 68.
    Minne L, et al. Laparoscopic vs. open appendectomy. Prospective randomized study of outcomes. Arch Surg 1997;132:708–711.PubMedGoogle Scholar
  69. 69.
    Golub R, Siddiqui F, Pohl D. Laparoscopic versus open appendectomy: a meta-analysis. J Am Coll Surg 1998;186:545–553.PubMedGoogle Scholar
  70. 70.
    Moberg AC, et al. Randomized clinical trial of laparoscopic versus open appendicectomy for confirmed appendicitis. Br J Surg 2005;92:298–304.PubMedGoogle Scholar
  71. 71.
    Katkhouda N, et al. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 2005;242:439–448.PubMedGoogle Scholar
  72. 72.
    Lau DH, et al. Comparison of needlescopic appendectomy versus conventional laparoscopic appendectomy: a randomized controlled trial. Surg Laparosc Endosc Percutan Tech 2005;15:75–79.PubMedGoogle Scholar
  73. 73.
    Cox MR, et al. Laparoscopic surgery in women with a clinical diagnosis of appendicitis. Med J Aust 1995;162:130–132.PubMedGoogle Scholar
  74. 74.
    Laine S, et al. Laparoscopic appendectomy—is it worthwhile? A prospective randomized study in young women. Surg Endosc 1997;11:95–97.PubMedGoogle Scholar
  75. 75.
    Fink AS, et al. Peri-appendicitis is a significant clinical finding. Am J Surg 1990;159:564–568.PubMedGoogle Scholar
  76. 76.
    Wang Y, Reen DJ, Puri P. Is a histologically normal appendix following emergency appendicectomy always normal? Lancet 1996;347:1076–1079.PubMedGoogle Scholar
  77. 77.
    Brasel KJ, Borgstorm DC, Weigelt JA. Cost-utility analysis of contaminated appendectomy wounds. J Am Coll Surg 1997;184:23–30.PubMedGoogle Scholar
  78. 78.
    Watters JM, et al. The influence of age on the severity of peritonitis. Can J Surg 1996;39:142–146.PubMedGoogle Scholar
  79. 79.
    Braveman P, et al. Insurance-related differences in the risk of ruptured appendix. New Engl J Med 1994;330:444–449.Google Scholar
  80. 80.
    Paajanen H, Kettunen J, Kostiainen S. Emergency appendectomy in patients over 80 years. Am Surg 1994;60:950–953.PubMedGoogle Scholar
  81. 81.
    Lim HK, Bae SH, Seo GS. Diagnosis of acute appendicitis in pregnant women: value of ultrasound. AJR Am J Roentgenol 1992;159:539–542.PubMedGoogle Scholar
  82. 82.
    Tamir IL, Bongard FS, Klein SR. Acute appendicitis in the pregnant patients. Am J Surg 1990;160:571–575.PubMedGoogle Scholar
  83. 83.
    To WW, Ngai CS, Ma HK. Pregnancies complicated by acute appendicitis. Aust N Z J Surg 1995;65:799–803.PubMedGoogle Scholar
  84. 84.
    Mahmoodian S. Appendicitis complicating pregnancy. South Med J 1992;85:19–24.PubMedGoogle Scholar
  85. 85.
    Kort B, Katz VL, Watson WJ. The effect of non-obstetric operation during pregnancy. Gynecol Obstet 1993;177:371–376.Google Scholar
  86. 86.
    Cohen-Kerem R, et al. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg 2005;190:467–473.PubMedGoogle Scholar
  87. 87.
    Amos JD, et al. Laparoscopic surgery during pregnancy. Am J Surg 1996;171:435–437.PubMedGoogle Scholar
  88. 88.
    Gurbuz AT, Peetz ME. The acute abdomen in the pregnant patient. Is there a role for laparoscopy? Surg Endosc 1997;11:98–102.PubMedGoogle Scholar
  89. 89.
    Rollins MD, Chan KJ, Price RR. Laparoscopy for appendicitis and cholelithiasis during pregnancy: a new standard of care. Surg Endosc 2004;18:237–241.PubMedGoogle Scholar
  90. 90.
    Whitney TM, et al. Appendicitis in the acquired immunodeficiency syndrome. Am J Surg 1992;164:467–470.PubMedGoogle Scholar
  91. 91.
    Savioz D, et al. Acute right iliac fossa pain in acquired immunodeficiency. Br J Surg 1996;83:644–646.PubMedGoogle Scholar
  92. 92.
    Lowy AM, Barie PS. Laparotomy in patients infected with human immunodeficiency virus: indications and outcome. Br J Surg 1994;81:942–945.PubMedGoogle Scholar
  93. 93.
    Flum DR, et al. Appendicitis in patients with acquired immunodeficiency syndrome. J Am Coll Surg 1997;184:481–486.PubMedGoogle Scholar
  94. 94.
    Van Noyen R, et al. Causative role of Yersinia and other enteric pathogens in the appendicular syndrome. Eur J Clin Microbiol Infect Dis 1991;10:735–741.PubMedGoogle Scholar
  95. 95.
    van Spreeuwel JP, et al. Campylobacter-associated appendicitis: prevalence and clinicopathologic features. Pathol Annu 1987;22:55–65.PubMedGoogle Scholar
  96. 96.
    Puylaert JB, et al. Campylobacter ileocolitis mimicking acute appendicitis: differentiation with graded-compression US. Radiology 1988;166:737–740.PubMedGoogle Scholar
  97. 97.
    Mattei P, Sola JE, Yeo CJ. Chronic and recurrent appendicitis are uncommon entities often misdiagnosed. J Am Coll Surg 1994;178:385–389.PubMedGoogle Scholar
  98. 98.
    Barber MD, McLaren J, Rainey JB. Recurrent appendicitis. Br J Surg 1997;84:110–112.PubMedGoogle Scholar
  99. 99.
    Klingensmith ME, Soybel DI, Brooks DC. Laparoscopy for abdominal pain. Surg Endosc 1996;10:1085–1087.PubMedGoogle Scholar
  100. 100.
    Warren JL, et al. Appendectomy incidental to cholecystectomy among elderly Medicare beneficiaries. Surg Gynecol Obst 1993;177:288–294.Google Scholar
  101. 101.
    Anderson BO, et al. The development and evaluation of a clinical test of surgical resident proficiency. Surgery 1989;106:347–352.PubMedGoogle Scholar
  102. 102.
    Deans GT, Spence RA. Neoplastic lesions of the appendix. Br J Surg 1995;82:299–306.PubMedGoogle Scholar
  103. 103.
    Nitecki SS, et al. The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg 1994;219:51–57.PubMedGoogle Scholar
  104. 104.
    Madwed D, Mindelzun R, Jeffrey RB. Mucocele of the appendix. AJR Am J Roentgenol 1993;159:69–72.Google Scholar
  105. 105.
    Cortina R, et al. Management and prognosis of adenocarcinoma of the appendix. Dis Colon Rectum 1995;38:848–852.PubMedGoogle Scholar
  106. 106.
    Carr NJ, McCarthy WF, Sobin LH. Epithelial noncarcinoid tumors and tumor-like lesions of the appendix. Cancer 1995;75:757–768.PubMedGoogle Scholar
  107. 107.
    Qizilbash AH. Mucoceles of the appendix: their relationship to hyperplastic polyps, mucinous cystadenomas, and cystadenocarcinomas. Arch Pathol 1995;99:548–555.Google Scholar
  108. 108.
    Misdraji J, et al. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol 2003;27:1089–1103.PubMedGoogle Scholar
  109. 109.
    Young RH. Pseudomyxoma peritonei and selected other aspects of the spread of appendiceal neoplasms. Semin Diagn Pathol 2004;21:134–150.PubMedGoogle Scholar
  110. 110.
    Modlin IM, et al. Current status of gastrointestinal carcinoids. Gastroenterology 2005;128:1717–1751.PubMedGoogle Scholar
  111. 111.
    O’Malley CD, Saunders JB de CM. Leonardo Da Vinci on the Human Body. New York: Schuman; 1952.Google Scholar
  112. 112.
    Silen W. Cope’s Early Diagnosis of the Acute Abdomen. 16th ed. New York: Oxford University Press; 1983.Google Scholar
  113. 113.
    Keighley MRB, Williams NS. Surgery of the Anus, Rectum and Colon. London: Saunders; 1993.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • David Soybel
    • 1
  1. 1.Division of General and Gastrointestinal Surgery, Brighams and Women’s HospitalBrigham and Women’s HospitalBostonUSA

Personalised recommendations