In 1886, Fitz1 assembled a large amount of autopsy data and reviewed the literature trying to understand what caused typhlitis and pelvic infections, disorders that were highly lethal at the time. He noted a range of pathologies, including mucosal inflammation, transmural inflammation, gangrene, and perforation of the appendix. Piecing it all together, Fitz concluded that appendicitis progressed from mild, mucosal disease to a transmural process that then caused the appendix to become gangrenous. Eventually, the appendix would perforate resulting in pelvic abscesses. Shortly after Fitz published his observations, appendectomy was shown to prevent pelvic abscess.2 The assumed progression of appendicitis from mild disease to perforation with appendectomy as the only means for preventing serious infection became established in medical thought and continues to guide appendicitis management.
Livingston E, Vons C. Treating Appendicitis Without Surgery. JAMA. 2015;313(23):2327–2328. doi:10.1001/jama.2015.6266
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