Source Control Options
ÎOperative intervention for acute, nonperforated appendicitis may be performed as soon as is reasonably feasible. Surgery may be deferred for a short period of time (< 24 hours) according to individual institutional circumstances (B-II).
ÎPatients with perforated appendicitis should undergo urgent intervention to provide adequate source control (B-III).
ÎBoth laparoscopic and open appendectomy are acceptable procedures, and use of either approach should be dictated by the surgeon's expertise in performing each procedure (A-I).
Nonoperative Management
ÎNonoperative management of selected patients with acute, nonperforated appendicitis can be considered if there is a marked improvement in the patient's condition prior to operation (B-II).
ÎNonoperative management may also be considered as part of a specific approach for male patients (with acute nonperforated appendicitis), provided that the patient is admitted to the hospital for 48 h and shows sustained improvement in clinical symptoms and signs within 24 h while receiving antimicrobial therapy (A-II).
ÎPatients with a well-circumscribed periappendiceal abscess can be managed with percutaneous drainage or operative drainage when necessary. Appendectomy is generally deferred in such patients (A-II).
ÎSelected patients who present several days after development of an inflammatory process and have a periappendiceal phlegmon or a small abscess not amenable to percutaneous drainage may delay or avoid a source control procedure to avoid a potentially more morbid procedure than simple appendectomy. Such patients are treated with antimicrobial therapy and careful inpatient follow-up, in a manner analogous to patients with acute diverticulitis (B-II).
ÎThe use of interval appendectomy after percutaneous drainage or nonoperative management of perforated appendicitis is controversial, and may not be necessary (A-II).
Abbreviations
CT, computerized tomography; g, gram; h, hour(s); kg, kilogram; mg, milligram; mos, months; MRI, magnetic resonance imaging; RLQ, right lower quadrant; US, ultrasonography; yr, year(s)
Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.
APP121122
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