Acute Appendicitis Over the Time. The Impact of Scientific Discoveries and Technological Advances on the Diagnosis and Treatment of Acute Appendicitis

Acute appendicitis is the touchstone of any surgeon. The most common surgical pathology, acute appendicitis, has known over time, depending on the level of scientific knowledge, different therapeutic approaches, from absolute surgical abstinence to absolute surgical indication. No other aspect of surgical pathology has created so many occasions of successes and undeserved failures. Technologization of surgery through the introduction of laparoscopy brought - in addition to indisputable advantages (but whose importance decreases, also indisputably, with patients' age) and additional factors of operative risk - a risk that increases with age and extent of the intervention. At the current time there are clinical studies that optionally support first-line antibiotic treatment for uncomplicated acute appendicitis, surgical treatment being reserved for complicated acute appendicitis. This differentiated therapeutic attitude is possible due to the progresses achieved in abdominal imaging exploration used in the diagnosis of acute appendicitis, including ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), which have allowed a correct morphopathological diagnosis of acute appendicitis. The clinical examination and continuous monitoring of the evolution are essential for the diagnosis and assessment of the effectiveness of the indicated treatment. Unfortunately, Dieulafoy's assertion from the Listerian period that "one should no longer die of acute appendicitis" is still relevant today, in the era of antibiotic therapy and technologization of surgery, as well as - especially - the completion made by Lejars, "with exceptions" ("sauf exceptions").