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Editor's Correspondence
Oct 22, 2012

Appendicitis: The Great Masquerader

Author Affiliations

Author Affiliation: Division of General Surgery, University of California, San Francisco.

Arch Intern Med. 2012;172(19):1525. doi:10.1001/archinternmed.2012.4424

Hsia et al1 reported a wide range of costs for appendectomy. However, the results of their study are not surprising, given the tremendous variability in presentation and treatment of this disease. Known as the “great masquerader,” appendicitis can mimic many other diseases, leading to diagnostic challenges, particularly in pregnant women.2 Acute appendicitis can range from minimal inflammation, suppuration, gangrene, perforation, abscess, and systemic sepsis. Treatment may involve either admission for observation, operation, or interventional radiologic procedures to drain abscesses, with possible intensive care unit stay and mechanical ventilation. Over the decades, it has been debated whether patients with acute nonperforated appendicitis can be discharged home with antibiotics3 and offered surgical intervention if they return with appendiceal perforation. Advanced cases of perforation with pelvic abscess can be treated with antibiotics and a percutaneous drain, and the patients can be discharged for elective interval appendectomy weeks later. For patients requiring immediate surgery, a question arises whether surgery should be performed via the open or laparoscopic route, and the answer will vary with patient preference and surgeon expertise. Another highly variable factor is the length of time a patient waits to undergo appendectomy, which is mediated by operating room availability and other hospital capacity factors that affect length of stay.

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