Diverse Presentations of Appendicitis: A Clinical Perspective

Abstract

Background: Acute appendicitis is among the most frequent surgical emergencies encountered worldwide and remains a predominantly clinical diagnosis supported by laboratory and imaging findings. Although the classical presentation of migratory right iliac fossa pain with anorexia, nausea, and localized tenderness is well recognized, a considerable proportion of patients present atypically. Variations in appendicular position, extremes of age, and underlying neoplastic disease of the appendix may all alter the clinical picture and delay definitive management. Case Series: We report three patients managed at a tertiary care teaching hospital who illustrate the breadth of this spectrum. The first, a 51-year-old male with a short history of right lower quadrant pain, was found on ultrasonography to have an appendicular mucocele; histopathology after laparoscopic appendectomy revealed a low-grade appendiceal mucinous neoplasm, and he underwent completion right hemicolectomy. The second, a 13-year-old girl, presented with generalized peritonitis secondary to a perforated appendix with an appendicolith and required emergency exploratory laparotomy with appendectomy. The third, a 54-year-old male, presented with lower abdominal pain radiating to the back accompanied by loose stools, mimicking a colonic or urological cause, and was managed by emergency open appendectomy. Conclusion: These cases demonstrate that appendicitis may present as uncomplicated inflammation, as established perforation with peritonitis, or as an incidentally detected neoplastic lesion. A structured approach combining careful history, clinical examination, appropriate imaging, and mandatory histopathological examination of every appendectomy specimen is essential to avoid missed diagnoses and to guide further management.