Atypical histories are not unusual and are more often associated with suppurative appendicitis. This condition often starts with right lower quadrant pain and may smolder with non-specific symptoms (e.g.,malaise,lethargy and/or fever) for several days before a diagnosis of appendicitis can be made. Diarrhea, a symptom of gastroenteritis, may occur if the appendiceal inflammation irritates adjacent intestine. Diagnosis is more difficult and surgery removes an appendix that is suppurative, gangrenous or ruptured.