Suspected Appendicitisa Men: Initial Evaluation symptom onset)
presentation (≤ 24 h from
Typical presentation Atypical Women: Initial Evaluation
Women not of childbearing age
childbearing age Women of Negative Male < 50 > 3 months
Helical CT or US
Either Helical CT ≤ 3 months US or MRI Appendicitis Confirmed Antimicrobial therapy, antipyretics, and pain management Unperforated Perforated
periappendiceal abscess
Circumscribed
≤ 24 h– open or laparoscopic
Surgery open or laparoscopic Urgent surgery–
Optional nonoperative management if improvingb
Uncertain Diagnosis evaluation Further
scanning, or 24- hour observation
Laparoscopy, limited CT
therapy ≥ 3 days, antipyretics, and pain management
Antimicrobial suspicion is high
Continued observation in-hospital if
a Algorithm is not a part of the guidelines but is based on the ideas contained therein. b
The use of interval appendectomy aſter percutaneous drainage or nonoperative management of perforated appendicitis is controversial and may not be necessary.
Percutaneous drainage aſter 24 hrsb
Periappendiceal phlegmon
Pregnancy test Positive
Careful inpatient follow-up
