Appendicitis Updated Review

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.

Amyand is credited with the first appendectomy in 1736, when he operated on a boy with an enterocutaneous fistula within an inguinal hernia.On exploration of the hernia sac, he discovered the appendix, which had been perforated by a pin resulting in a fecal fistula. As a result of his original description, an inguinal hernia containing the appendix carries Amyand’s eponym to this day.Nearly 150 years passed until Lawson Tait in London presented the first successful transabdominal appendectomy for gangrenous appendix in 1880. Less than a decade later, in 1886, Reginald Fitz of Harvard Medical School first described the natural history of the inflamed appendix, coining the term “appendicitis.”In 1889, Charles McBurney of the Columbia College of Physicians and Surgeons in New York presented his series of cases of surgically-treated appendicitis and in so doing described the anatomic landmark that now bears his name. McBurney’s point is the location of maximal tenderness “very exactly between an inch and a half and two inches from the anterior spinous process of the ileum on a straight line drawn from that process to the umbilicus.”In the 1890s, Sir Frederick Treves of London Hospital advocated conservative management of acute appendicitis followed by appendectomy after the infection had subsided; unfortunately, his youngest daughter developed perforated appendicitis and died from such treatment.

Numerous advances in the diagnosis and treatment of appendicitis have emerged in the past 125 years. Nonetheless, acute appendicitis continues to challenge surgeons to this day.