Classically, there is initially a colicky periumbilical pain which migrates to the right lower quadrant and becomes more severe. Diarrhea and loose stools are also common, often preceding the acute attack by hours to days.
Leukocytosis typically follows.
The order in which these signs and symptoms develop is fairly rigid and does not usually vary. Muscle guarding is common, but may be absent following perforation. Rebound tenderness is a sign of peritonitis. Rectal exam may show marked tenderness in the case of a low lying appendix. Positive psoas and obturator signs indicate inflammation adjacent to these muscles.