A 28-year-old woman presents with acute right lower quadrant pain, fever (38.5°C), and leukocytosis (WBC 14,000/µL). Clinical examination reveals McBurney's point tenderness, positive Rovsing's sign, and rebound tenderness. Ultrasound confirms acute appendicitis. Regarding the pathophysiology and clinical features of acute appendicitis, all of the following are true EXCEPT:

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