Regarding the pathophysiology, diagnosis, and management of acute appendicitis, all of the following statements are correct EXCEPT:

Explanation

## Diagnosis and Management of Acute Appendicitis ### Pathophysiology: Obstruction Theory **Key Point:** Luminal obstruction (fecalith 30%, lymphoid hyperplasia, tumor, stricture) leads to: 1. Increased intraluminal pressure 2. Bacterial overgrowth 3. Mucosal ischemia 4. Transmural inflammation → perforation if untreated Option 0 is **correct**. ### Imaging: Ultrasound vs. CT **High-Yield:** While ultrasound is operator-dependent and excellent in pediatric/pregnant patients, **CT has superior sensitivity and specificity overall**: | Modality | Sensitivity | Specificity | Advantages | Limitations | |----------|-------------|------------|------------|-------------| | **Ultrasound** | 85–90% | 90–95% | No radiation; good in pregnancy/children | Operator-dependent; limited in obese patients | | **CT (MDCT)** | 94–98% | 95–99% | High accuracy; less operator-dependent; shows complications | Radiation; contrast allergy risk | **Option 1 is INCORRECT** — CT, not ultrasound, has superior sensitivity and specificity in most populations. Ultrasound is preferred in **specific groups** (pregnancy, pediatrics) but not universally superior. ### Surgical Management **Clinical Pearl:** Laparoscopic appendicectomy is now standard of care in most centers: - Lower wound infection rates - Faster recovery and return to work - Reduced postoperative pain - Better cosmesis - Allows exploration for alternative diagnoses Option 2 is **correct**. ### Perforation Risk **Warning:** Perforation risk: - <24 hours: ~5% - 24–48 hours: ~20% - >48 hours: ~30–40% Early surgery prevents sepsis, peritonitis, and abscess formation. Option 3 is **correct**.