Acute appendicitis as a complication of typhoid fever A case report.

Abstract

Acute appendicitis, a leading cause of abdominal pain in adults and children, has mortality rates of 8.6% in men and 6.7% in women, with an annual incidence of 96.5 to 100 cases per 100,000 adults. Its etiology includes luminal obstruction due to fecalith, lymphoid hyperplasia, impacted feces, tumors and infectious agents. The Alvarado score stratifies the management of appendicitis between simple (non-perforated) and complex (gangrenous or perforated) inflammation. The diagnosis is made through history, physical examination, laboratory tests and imaging techniques. Although appendectomy is the standard treatment, broad-spectrum antibiotics can successfully treat uncomplicated acute appendicitis in 70% of patients. A meta-analysis in Germany revealed that about 37% of conservatively treated adult patients undergo an appendectomy within one year. Pain management is a priority, avoiding late or unnecessary interventions. Perforation can cause sepsis and occurs in 17% to 32% of cases. The risk increases with prolonged duration of symptoms before surgery. In moderate to high risk patients, prompt surgical consultation should be performed to reduce morbidity and mortality from perforation.

Salmonella typhi and paratyphi infections can cause an acute abdomen due to intestinal perforations and salpingitis, and in rare cases, appendicitis. On the other hand, nontyphoid salmonella, which usually causes self-limited gastroenteritis, is rarely associated with appendicitis. Salmonella species, through a sophisticated virulence system, adhere to and invade enterocytes. This triggers an inflammatory response that can manifest with a variety of gastrointestinal symptoms, from constipation to diarrhea, and in complicated cases, can lead to intestinal bleeding or perforation. Enteric pathogens may play a role in the onset of acute appendicitis, possibly through their influence on hyperplasia of lymphoid tissue in the appendix. Additionally, these pathogens can present symptoms that mimic appendicitis. A case is presented at the Alcívar Hospital Medical Conferences.