On the basis of experimental confirmation, acute appendicitis seems to be the end result of a primary obstruction of the appendix lumen. Once this obstruction occurs the appendix subsequently becomes filled with mucus and swells, rising pressures within the lumen and the walls of the appendix, resulting in thrombosis and occlusion of the small vessels, and stasis of lymphatic flow. Rarely, natural recovery can occur at this point. As the previous progresses, the appendix becomes ischemic and then necrotic. As bacteria begin to leak out through the dying walls, pus forms inside and around the appendix (suppuration).
The end result of this cascade is appendicle rupture causing peritonitis, which may lead to septicemia and finally death. Among the causative agents, such as foreign bodies, trauma, intestinal worms, and lymphadenitis, the amount of an obstructing fecalith has attracted attention. The prevalence of fecaliths in patients with appendicitis is much higher in developed than in developing countries, and an appendiceal fecalith is usually associated with complicated appendicitis. Moreover, fecal stasis and arrest may play a role, as demonstrated by a significantly lower number of bowel movements per week in patients with acute appendicitis compared with healthy controls.
The end result of this cascade is appendicle rupture causing peritonitis, which may lead to septicemia and finally death. Among the causative agents, such as foreign bodies, trauma, intestinal worms, and lymphadenitis, the amount of an obstructing fecalith has attracted attention. The prevalence of fecaliths in patients with appendicitis is much higher in developed than in developing countries, and an appendiceal fecalith is usually associated with complicated appendicitis. Moreover, fecal stasis and arrest may play a role, as demonstrated by a significantly lower number of bowel movements per week in patients with acute appendicitis compared with healthy controls.
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