Appendicitis is a condition characterised by inflammation of the appendix. While mild cases may resolve without treatment, most require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly due to peritonitis and shock.. . Appendicitis can be classified into two types, typical and atypical. The pain of typical acute appendicitis usually starts centrally (periumbilical) before localising to the right iliac fossa (the lower right side of the abdomen). There is usually associated loss of appetite and fever. Nausea, or vomiting may or may not occur. These classic signs and symptoms are more likely the younger the patient. Older patients (beyond their teenage years) may present with only one or two. Diagnosis is easier in typical acute appendicitis and surgery removes a swollen, appendix with little or no suppuration (pus) if operated early (within 24 hours of onset).. . Atypical histories are not unusual and are more often associated with suppurative appendicitis. This condition often starts with right lower quadrant pain and may smolder for several days before a diagnosis of appendicitis can be made. Diagnosis is more difficult and surgery removes an appendix that is suppurative, gangrenous or ruptured.. . There is typically pain and tenderness in the right iliac fossa in both typical and atypical (suppurative) appendicitis. Rebound tenderness may be present suggesting that there is some element of peritoneal irritation. If the abdomen is guarded, there should be a strong suspicion of peritonitis requiring urgent surgical intervention.