Increasing intraluminal pressures eventually exceed capillary perfusion pressure, which is associated with obstructed lymphatic and venous drainage and allows bacterial and inflammatory fluid invasion of the tense appendiceal wall. Transmural spread of bacteria causes acute suppurative appendicitis. Appendectomy can be performed using either a laparoscopic or an open technique , more difficult cases with gangrenous appendicitis were more likely to require open appendectomy. In the hands of experts, laparoscopic appendectomy is feasible even in such complicated cases.
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