<prompt> The most common mechanism of perforation in appendix isImpacted fecolithTension gangreneNecrosis of lymphoid patchRetrocecal infection  <response>: Appendicular Perforation Immediate appendectomy has long been the recommended treatment for acute appendicitis because of the presumed risk of progression to rupture The overall rate of perforated appendicitis is 25.8 Children 5 years of age and patients 65 years of age have the highest rates of perforation 45 51 respectively Risk factors for Appendicular Perforation Fecolith Diabetes mellitus Immunosuppression Extremes of age Pelvic appendix Previous abdominal surgery It has been suggested that delays in presentation are responsible for the majority of perforated Appendices Appendiceal rupture occurs most frequently distal to the point of luminal obstruction along the anti mesenteric border of the appendix Rupture should be suspected in the presence of fever with a temperature of 39 102degF and a WBC count of 18000 cellsmm3 MC bacteria isolated in perforated appendicitis : Bacteroides fragilis 80 E.coli 77 Ref: Sabiston 20th edition Pgno : 1297 