**1. Introduction**

Appendicitis is an inflammation of the vermiform appendix, which presents as one of the causes of acute abdomen leading to emergency surgical indication. The acute appendicitis presented as the most common indication of nontraumatic emergency surgeries around the world. Annually, more than 100 cases of appendicitis per 100,000 persons are recorded around the world. About 16.33% of men and 16.34% of women mostly in the second and third decades of life were at risk of experiencing acute appendicitis [1, 2].

More than 108,000 surgical procedures were conducted to treat appendicitis in a year. Acute appendicitis may be treated with surgical treatment and conservative treatment. Treatment choices were considered in acute appendicitis by classification of clinical uncomplicated or complicated appendicitis occurred [3].

Distinguishing indications of surgery or appendectomy as treatment of appendicitis might be challenging. It was more subtle in pediatric patients, as more consideration and careful examination needed to be conducted prior to the surgical procedure. Statistics had recorded more events of negative appendectomy, the fact that vermiform appendix presented to be normal or not inflamed after the process of appendectomy. The incidence was commonly only about 15% in adults but raised up to 56.7% or even more in pediatric patients presenting with related symptoms to appendicitis. These procedures were stated as a burden in medical decision-making as non-indicative surgeries may harm patients or even cause expenditures for non-beneficial procedures [4].

The main aim of diagnostic and decision-making in appendicitis was to accurately distinguish any chance of currently symptomatic appendicitis appearing normal as presented during operation. This means that appendicitis may be reversible and basic inflammation of the appendicitis was not causing permanent damage to the appendix vermiform itself. Currently, there was still no such strong evidence to prove whether an appendicitis process that occurred would end as permanent tissue damage and causes complications that are mandatory for surgical treatment of the appendix vermiform or would heal without risk of complications [5].

We analyzed the possibilities of differentiation of the two conditions in appendicitis. The main key to understand and accurately differentiate risk in appendicitis would be clearly explained in a basic inflammatory mechanism on how appendicitis would occur. The promising approach was glancing at the pathways and mechanism of inflammation would occur specifically, as related with factors lying alongside the pathophysiological process of inflammation and cure of the inflammation itself, by sufficient oxygenation and adequate metabolism of remodeling or tissue repair.
