[Diagnosis and treatment of acute appendicitis].

The diagnosis and treatment of acute appendicitis are described with emphasis on the significance of ultrasonography, computed tomography (CT), and laparoscopic appendectomy. The diagnosis of acute appendicitis has traditionally been made by physical examination and blood tests. However, use of ultrasonography and CT as well as these conventional methods makes more precise diagnosis possible. These imaging modalities are useful for determining whether surgery is necessary. Ultrasonography is easy to perform and minimally invasive, making it essential for diagnosis. This examination can visualize hypertrophy, disturbance, and disruption of the layered structure of the appendiceal wall, accumulation of purulent fluid, and the presence of a fecolith in the appendix. In catarrhal appendicitis, the wall of the appendix consists of three layers. In phlegmonous appendicitis, these layers become unclear, and in gangrenous appendicitis, the layered structure is lost. CT is superior to ultrasonography in objectivity, but is unable to depict the layers of the appendiceal wall. It is useful for demonstrating periappendiceal fat, ascites, and abscess formation, and for determining whether an operation is necessary based on these findings. Laparoscopic appendectomy is one of the choices for obese patients, young women, and patients in whom a condition other than acute appendicitis is suspected.