Guidelines
Appendicitis

Appendicitis

Refers to acute inflammation and subsequent infection of the vermiform appendix

Surgical consultation for all patients

Blood cultures in severely ill and health care associated complicated infections; appendectomy cultures not needed

Procalcitonin (PCT) not usually useful

Empiric Therapy

Infection not extending beyond the appendix, without perforation, phlegmon or abscess

Presence of perforation, phlegmon or abscess

Pre-operative fecal peritonitis (free perforation)

While evidence supporting antibiotic only management of uncomplicated appendicitis is mounting, controversy exists regarding:

  • accuracy of imaging in distinguishing uncomplicated vs. complicated (perforated) disease
  • risk to elderly, immunocompromised or those with multiple co-morbidities
  • eventual need for appendectomy after > 1 year (it is currently estimated to be ~15-30% during the first year)

Non-operative management is not routinely recommended by guidelines but can be considered in select cases

For stable perforated appendicitis treated by an initial non-operative approach, see Complicated