Acute appendicitis is an acute septic inflammatory disease with an incidence rate of about 1:1000 and can occur in people of any age, so the general public seems to know a lot about this disease. But in fact, the diagnosis and treatment of acute appendicitis is not as simple and easy as one might think. The claim that appendicitis is a minor surgery may be based on three “theoretical foundations”. 1. Small appendix: The appendix is earthworm-shaped and attached to the wall of the cecum. Most people have an appendix that is only a few centimeters long and probably no more than 1 cm in diameter. 2. Small incision for acute appendicitis surgery: The incision length is only a few centimeters, which is naturally the best example of a minor surgery. And at some point, the size of the incision becomes an indicator for the patient to measure the quality of the surgery. The young doctors who are just starting to get in touch with the surgery must be appendicitis, and the legendary story of “so-and-so Xiaoli a knife” removing the appendix in just a few minutes is often circulated among the public, so whether in the minds of patients or doctors, appendectomy becomes a surgery that is not a surgery, and the technical content is ignored and becomes a victim of time. 3, the incidence of the disease is high, most of the public have heard or experienced: acute appendicitis can occur at any age, especially more in young people, stomach pain is also in the right lower abdomen, the other places are fine, after the surgery friends and relatives visit to exchange once experience, by the way comfort the patient, the surgery naturally becomes small again. Is acute appendicitis really that simple? The answer is no. The author’s series of professional analysis, I hope to the public in-depth understanding of how acute appendicitis is really a disease. 1, the complexity of appendiceal anatomy: the appendix is generally at the meeting point of the three colonic bands and the cecum, the appendix base and cecum relationship is constant, so the location of the appendix also changes with the location of the cecum. In addition to the common position, it can also be as high as the subhepatic, as low as the pelvis, or even cross the midline to the left. The appendix may be positioned anywhere within a 360 degree range centered on its base. There are at least six types of appendiceal tip pointing: ① anterior ileocecal; ② pelvic; ③ posterior cecum; ④ inferior cecum; ⑤ lateral cecum; and ⑥ posterior ileocecal. Among them, the most likely location to be removed is the anterior ileum, which is the situation that doctors may often refer to as “the appendix will pop out by itself if you cut open the stomach”. The posterior appendix is not so easy to find, especially the appendix of intra-mural type, which is more difficult to remove, and then the ileocecal part needs to be free and placed on the outside of the incision for careful investigation. 2, the instability of the patient’s symptoms: the early stage of the onset of acute appendicitis is mainly manifested as epigastric discomfort, malignancy, vomiting and other symptoms, when it is often diagnosed as acute gastritis and other conditions. In this regard, it is often difficult for the general public to understand why acute gastroenteritis is diagnosed when it is clearly appendicitis. These two organs are too far apart! In fact, there is a specific anatomical basis for this condition. The nerves of the appendix enter the spinal cord at the 10th and 11th thoracic segments, while the 10th spinal nerve is located in the upper abdomen and around the umbilicus, so when a patient develops appendicitis, it often causes discomfort and pain in other areas, which is medically known as referred pain. The change in symptoms of acute appendicitis is closely related to the stage of disease development and is not invariably manifested as stomach pain. In the early stage of the disease, patients often have only epigastric discomfort, nausea and vomiting, and their pathological type is acute simple appendicitis. After 4-8 hours, the pain is gradually fixed in the right lower abdomen, and if the inflammation is further aggravated or if there are fecal stones causing obstruction of the appendiceal cavity, the disease will gradually progress to acute suppurative appendicitis, with marked swelling of the appendix and accumulation of pus in the cavity and even in all layers of the appendiceal wall. Thin pus appears in the peritoneal cavity around the appendix, forming a limited peritonitis. At this time, the pain is often progressively worse, the bacterial spread leads to inflammatory reaction with fever, and localized muscle tension begins to appear, with more pronounced pressure and rebound pain in the right lower abdomen. In acute appendicitis, the appendix may be perforated, but there is sometimes no necessary connection between perforation and the time of onset. When some patients come to the hospital for emergency treatment, the appendix is often already perforated, and under the action of the body’s own protective mechanism, the surrounding intestinal canal and large omentum and other tissues will try to wrap around the perforated appendix to form a periappendiceal abscess. The abscess can be gradually absorbed. If the abscess wall is not firmly formed, or if a small amount of intestinal contents has flowed into the abdominal cavity before the abscess is formed, the patient may have more serious abdominal pain and may also have symptoms such as intestinal obstruction. 3. Uncertainty of surgery: The notion that surgery for appendicitis is a minor operation can be deep-rooted, so it is often difficult for the public to understand when complications arise. However, the fact is that surgery for acute appendicitis is not just an appendectomy. It is true that appendectomy is not considered a major surgery, but even if it is considered a minor surgery, it should be called a minor open surgery. The possibility of complications in any surgery is directly related to the surgery itself. In another word, the choice of surgery means that you also choose the possible complications of the surgery.