Profuse vomiting may indicate development of generalised peritonitis after perforation but is rarely a major feature in simple appendicitis. Loss of appetite is often a predominant feature, and constipation and nausea are often present.
The initial pain represents a referred pain resulting from the visceral innervation of the midgut, and the localised pain is caused by involvement of the parietal peritoneum after progression of the inflammatory process. 4 Typically, the patient describes a peri-umbilical colicky pain, which intensifies during the first 24 hours, becoming constant and sharp, and migrates to the right iliac fossa. The diagnostic sequence of colicky central abdominal pain followed by vomiting with migration of the pain to the right iliac fossa was first described by Murphy but may only be present in 50% of patients. Abdominal pain is the primary presenting complaint of patients with acute appendicitis.
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