The appendix is diffusely swollen and the serosa reddened; there is a patchy exudate apparent; the
cut surface of the appendix shows a faecolith and a thickened, inflamed mucosa.
This man, at the age of 20, was admitted to hospital with abdominal pain; this had begun
some four days previously with sudden onset of acute pain in the right iliac fossa, but no
accompanying nausea or vomiting. The pain was intermittent. Three days before admission his
appetite had declined; two days before admission the pain was still present, radiating around to the
back on the right side. At this stage he developed diarrhoea. Examination showed a mass in the
right iliac fossa; the total white count was 19.6 thousand, 86% neutrophils.