Physicians view the appendix with mixed emotions. Pediatricians constantly worry about it, radiologists want it filled with air or barium,1,2 psychiatrists do not bother with it, surgeons are moved by it, and internists are seldom interested in it. Since appendicitis is primarily a surgical disorder, it seems appropriate that the internist's major responsibility traditionally has been reduced to simply (but promptly) securing a surgical consultation. This may not always be the case, however. In an attempt to rekindle interest and upgrade the status of this oftenneglected appendage,3 the following discussion touches briefly on five selected aspects of acute appendicitis that we should be concerned about and can meaningfully participate in.
Just over half of patients present with the well-known, classic visceral-somatic pain sequence accompanied by fever, rebound tenderness, muscle guarding, cutaneous hyperesthesia, and right-sided pelvic tenderness on rectal examination.4 In the remaining patients diagnosis is