>
Suspected Appendicitis* Men: Initial Evaluation symptom onset)
presentation (≤ 24 h from
Typical presentation Atypical Women: Initial Evaluation
childbearing age Women of child- Women not of
bearing age Pregnancy test Negative > 3 months Either Helical CT Appendicitis Confirmed Unperforated Perforated
peri-appendiceal abscess
Circumscribed
Peri-appendiceal phlegmon
Antimicrobial therapy, antipyretics, and pain management
≤ 24 h open or laparoscopic
Surgery
Urgent surgery- open or
laparoscopic
Optional non-operative management if improving†
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
*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.
operative drainage† Percutaneous or
Careful inpatient follow-up
Positive
≤ 3 months US or MRI
