Case report and systematic review of blunt abdominal trauma as a cause of acute appendicitis

ABSTRACT

Acute appendicitis commonly presents as an acute abdomen. Cases of acute appendicitis caused by blunt abdominal trauma are rare. The aetiology and pathphysiology of appendicitis have been well investigated. However, the occasional cases of co-existent appendicitis and blunt abdominal trauma raise questions regarding a possible cause/effect relationship. We present a case and review of appendicitis following blunt abdominal trauma. The aim of this study is to collate and report the clinical presentations and experience of such case by internet search using PubMed and the keywords 'appendicitis', 'abdominal' and 'trauma' a literature review was carried out. The initial search returned 382 papers, of which 18 articles were included. We found 29 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2010. Mechanisms of injury included road traffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, also nausea, vomiting and anorexia. Only 13 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis. Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trama especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after blunt abdominal trauma with right lower quadrant pain and tenderness should undergo urgent imaging with a plan to proceed to appendicectomy if the imaging suggested an inflammatory process within the right iliac fossa