Historically perforated appendix take longer to present and symptoms are often more generalized and patient usually have taken antibiotics. But my question is why appendix perforates ? Many cases with acute appendicitis resolve with conservative treatment - why all don't perforate ??
Ischemia of the bowel wall?
Pressure necrosis?
raised intra-luminal pressure ?
thrombosis of vessels?
any other
It is recognized that the obstruction of the appendiceal lumen is the most important factor, but not the only one. Ischemia and necrosis usually follow the obstruction. Previous inflammatory episodes could also contribute to early perforation even without obstruction. Foreign bodies are seldom the primary cause. Certainly, perforation is not necessarily the evolution of acute appendicitis, sometimes the process can revert with or without medical treatment.
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