Appendicitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Farwa Haideri [2]

## Overview

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Appendicitis may be classified based on based on the duration of symptoms, based on etiology of obstruction and based on whether appendix has been perforated or not.

## Classification

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### Based on cause of Obstruction

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Appendicitis may be classified based on the etiology of obstruction into:[1]

* Infectious appendicitis - Obstruction of appendicial lumen is due to infectious inflammation[2].
* Fibrosis appendicitis- Scar tissue from a previous surgery can lead to obstruction.
* Fecaliths appendicitis - Hard fecal masses block the outlet of appendix
* Neoplasic appendicitis - Carcinoid, adenocarcinoma, or mucocele is responsible for increased secretions resulting in blockage.
* Parasitic appendicitis- In endemic areas obstruction of the appendicial lumen is due to parasitic load.
* Calculic appendicitis
* Lymphoid hyperplasic appendicitis Obstruction of lumen due cell hyperplasia.

### Based on Perforation

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Appendicitis may be classified based on perforations or non-perforations[3].

Perforating appendicitis

* The appendiceal wall has been compromised due to pressure and inflammation and the intraluminal contents have leaked out into the peritoneal cavity.
* Increases in incidence with age and is associated with the following types of bacterial infiltration:[4]
* Escherichia coli
* Peptostreptococcus
* Bacteroides fragilis
* Pseudomonas species

Non-perforating appendicitis

* Inflammation is contained within the appendix; no intraluminal contents have leaked out.

### Based on duration of symptoms

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Appendicitis may be classified based on duration of symptoms into:

##### Acute appendicitis

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* Symptoms have existed less than 48 hours.

Non acute appendicitis

* Symptoms have existed for days or weeks, or have recurred several times.

## References

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1. ↑ Yelon, Jay A. & Luchette, Fred A. (2014), Geriatric Trauma and Critical Care (1st ed.), New York, New York: Springer
2. ↑ Gomes CA, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F, Inaba K, Demetriades D, Gomes FC, Gomes CC (2015). "Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings". World J Emerg Surg. 10: 60. doi:10.1186/s13017-015-0053-2. PMC 4669630. PMID 26640515.
3. ↑ de Wijkerslooth E, van den Boom AL, Wijnhoven B (February 2019). "Variation in Classification and Postoperative Management of Complex Appendicitis: A European Survey". World J Surg. 43 (2): 439–446. doi:10.1007/s00268-018-4806-4. PMC 6329835. PMID 30255334. Vancouver style error: initials (help)
4. ↑ Luckmann R (1989). "Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age". Am. J. Epidemiol. 129 (5): 905–18. PMID 2784936. Unknown parameter `|month=` ignored (help)

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