When is an immediate (emergent) appendectomy indicated in the treatment of appendicitis?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Historically, immediate (emergent) appendectomy was recommended for all patients with appendicitis, whether perforated or unperforated. More recent clinical experience suggests that patients with perforated appendicitis with mild symptoms and localized abscess or phlegmon on abdominopelvic computed tomography (CT) scans can be initially treated with IV antibiotics and percutaneous or transrectal drainage of any localized abscess. If the patient's symptoms, WBC count, and fever satisfactorily resolve, therapy can be changed to oral antibiotics and the patient can be discharged home. Then, delayed (interval) appendectomy can be performed 4-8 weeks later.

The above approach is successful in the vast majority of patients with perforated appendicitis and localized symptoms. Some have suggested that interval appendectomy is not necessary, unless the patient presents with recurrent symptoms. Further studies are needed to clarify not only whether routine interval appendectomy is indicated but also to identify the optimal treatment strategy in patients with perforated appendicitis

Go to Appendectomy and Pediatric Appendectomy for more information on these topics.


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