[Current therapy of complicated appendicitis]

A significant number of complications in acute appendicitis develop due to delayed or even missed diagnosis. Potentially every patient can be affected due to a distinct feature of appendicitis--the rapidity with which the inflammation passes through the different stages. Even after a few hours, gangrenous appendicitis with impending overt perforation can have developed. In many cases, the term complicated appendicitis may be less significant than implied because, e.g., the rapidly developed perforation can be treated by appendectomy, which rarely presents a surgical challenge. However, every perforation of a hollow viscus in the abdomen leads to peritonitis of different degrees, which untreated can end lethally. The often cited statement of Dieu la Foy from the last but one century "no patient has to die from appendicitis" remains a surgical dream not quite fulfilled. Occasionally even today, patients with comorbidity die from the sequelae of appendicitis, i.e., high-risk groups including the very young and the very old and immunosuppressed patients. These patients should receive special attention when the diagnosis of appendicitis is considered. By definition, complicated appendicitis includes perforation of the appendix, empyema or abscess formation, and finally fecal peritonitis. The surgical procedure chosen and when to add supportive measures will depend on the specific complication present. Early or immediate appendectomy, i.e., the urgent indication to operate, is a generally accepted concept in the therapy of acute appendicitis. Even in complicated cases, the aim is just one operative procedure or if need be only the application of antibiotics.