Epidemiology, etiology, pathogenesis, and pathological underlying in acute appendicitis

Acute appendicitis remains one of the most frequent surgical emergencies worldwide, affecting approximately 10% of the population, with peak incidence in the second and third decades of life. Although its overall incidence has remained stable, the last two decades have witnessed evolving management strategies, including non-operative treatment for uncomplicated cases and interval appendectomy. The pathogenesis of acute appendicitis is multifactorial, traditionally attributed to luminal obstruction and subsequent bacterial infection. Alternative theories emphasize viral triggers, vascular spasm, allergic reactions, and environmental factors such as diet and air quality. The appendix is now recognized as an organ with neuroendocrine and immunological functions rather than a vestigial structure.Histopathological and clinical classifications distinguish between uncomplicated and complicated appendicitis, with the latter encompassing phlegmonous, gangrenous, and perforated forms. Modern imaging-based systems, such as the Classification of Acute Appendicitis (CAA), integrate radiological findings to guide management. Despite extensive research, the disease’s pathophysiology remains incompletely understood. Continued multidisciplinary investigation is required to refine diagnostic accuracy, optimize therapeutic algorithms, and reduce postoperative complications.