What is appendicitis that is extremely prone to perforation?
Nov 05, 2025
Source: Cainiu Health
Dr. Huang Yuhong
Introduction
Gangrenous appendicitis usually develops from simple appendicitis or suppurative appendicitis. Persistent and worsening obstruction within the appendiceal lumen leads to massive bacterial proliferation and toxin production, resulting in vascular thrombosis, ischemia, and necrosis of the appendix wall. The entire wall—ranging from the mucosal to the serosal layer—is affected, becoming fragile and losing normal elasticity, making perforation highly likely under intraluminal pressure.
Generally, gangrenous appendicitis is the type most prone to perforation. In this condition, the entire wall of the appendix undergoes necrosis, becoming weak and fragile, thus significantly increasing the risk of rupture compared to other types of appendicitis. If unusual abdominal pain occurs, prompt medical attention is recommended. Detailed analysis is as follows:
Gangrenous appendicitis usually develops from simple or suppurative appendicitis. Persistent and worsening obstruction within the appendix lumen leads to massive bacterial proliferation and toxin production, causing vascular thrombosis in the appendix wall, followed by ischemia and tissue necrosis. The inflammation affects all layers of the appendix wall—from mucosa to serosa—making the tissue brittle and losing normal elasticity. Under intraluminal pressure, the weakened wall is highly susceptible to perforation. Once perforated, pus and bacteria can spill into the abdominal cavity, leading to peritonitis.
Patients with gangrenous appendicitis typically experience severe and progressively worsening abdominal pain, which may spread to a broader area, accompanied by systemic symptoms such as high fever, chills, nausea, and vomiting. Abdominal examination often reveals significant tenderness, rebound tenderness, and muscle rigidity, indicating advanced inflammation. Without timely treatment, perforation can occur rapidly. Prompt diagnostic evaluation and intervention are essential.
When experiencing severe abdominal pain along with high fever and abdominal muscle rigidity, do not self-administer painkillers, as this may mask symptoms and delay diagnosis. Once diagnosed, it is crucial to actively cooperate with medical treatment to prevent delays that could lead to perforation and serious complications.
