Introduction
The vermiform appendix is considered by most
to be a vestigial organ, its importance in surgery due only to its propensity
for inflammation which results in the clinical syndrome known as acute
appendicitis. Acute appendicitis is the most common cause of an ‘acute
abdomen’ in young adults, and as such the associated symptoms and signs have
become a paradigm for clinical teaching. Appendicitis is sufficiently common
that appendicectomy (termed appendectomy in North America) is the most
frequently performed urgent abdominal operation, and is often the first major
procedure performed by a surgeon in training. Yet, despite extraordinary
advances in modern radiographic imaging and diagnostic laboratory
investigations, the diagnosis of appendicitis remains essentially clinical
requiring a mixture of observation, clinical acumen and surgical science. In an
age accustomed to early and accurate preoperative diagnosis, acute appendicitis
remains an enigmatic challenge and a reminder of the art of surgical diagnosis.