IDSA GUIDELINES Bundle (free trial)

Complicated Intra-Abdominal Infection

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> Suspected Appendicitis* Men: Initial Evaluation Typical presentation (≤ 24 h from symptom onset) Atypical presentation Women: Initial Evaluation Women not of childbearing age Women of child- bearing age Pregnancy test Negative > 3 months Either Helical CT Appendicitis Confirmed Unperforated Perforated Circumscribed peri-appendiceal abscess Peri-appendiceal phlegmon Antimicrobial therapy, antipyretics, and pain management Surgery ≤ 24 h open or laparoscopic Urgent surgery- open or laparoscopic Optional non-operative management if improving† Uncertain Diagnosis Further evaluation scanning, or 24- hour observation Laparoscopy, limited CT therapy ≥ 3 days, antipyretics, and pain management Antimicrobial suspicion is high *Algorithm is not a part of the guidelines but is based on the ideas contained therein. †The use of interval appendectomy aſter percutaneous drainage or nonoperative management of perforated appendicitis may not be necessary. Continued observation in-hospital if Percutaneous or operative drainage† Careful inpatient follow-up Positive ≤ 3 months US or MRI

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