<a href=”http://www.appendicitisreview.com/wp-content/uploads/2009/10/pain.gif”><img class=”alignleft size-full wp-image-109″ title=”pain” src=”http://www.appendicitisreview.com/wp-content/uploads/2009/10/pain.gif” alt=”pain” width=”180″ height=”180″ /></a>As always, the diagnosis begins with a thorough history and physical examination. The patient should be asked about the classic symptoms of appendicitis, but the surgeon should not be dissuaded by the absence of many of the symptoms. Many patients with acute appendicitis do not have a classic history. Because the differential diagnosis of appendicitis is extensive, patients should be queried about certain symptoms that may suggest an alternative diagnosis. Surgeons must also remember that a previous appendectomy does not definitively exclude the diagnosis of appendicitis, as “stump appendicitis” (appendicitis in the remaining appendiceal stump after appendectomy), although rare, has been described.
The first descriptions of the appendix date to the sixteenth centuryAlthough first sketched in the anatomic notebooks of Leonardo da Vinci around 1500, the appendix was not formally described until 1524 by da Capri and 1543 by Vesalius.Perhaps the first description of a case of appendicitis was by Fernel in 1554, in which a 7-year-old girl with diarrhea was treated with a large quince. Soon thereafter she developed severe abdominal pain and died. Autopsy showed that the quince had obstructed the appendiceal lumen, resulting in appendiceal necrosis and perforation. For the next few centuries, such cases of appendicitis were typically diagnosed at autopsy.