>
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
