Fast Five Quiz: How Much Do You Know About Appendicitis?

Jaime Shalkow, MD

Disclosures

December 09, 2016

The following three treatment categories are generally recognized for an appendiceal mass:

  • Patients with a phlegmon or a small abscess: After intravenous antibiotic therapy, interval appendectomy can be performed 4-6 weeks later.

  • Patients with a larger well-defined abscess: After percutaneous drainage with intravenous antibiotics, the patient can be discharged with the catheter in place. Interval appendectomy can be performed after the fistula is closed.

  • Patients with a multicompartmental abscess: These patients require early surgical drainage.

Historically, immediate (emergent) appendectomy was recommended for all patients with appendicitis, whether perforated or imperforated. More recent clinical experience suggests that patients who have perforated appendicitis with mild symptoms and localized abscess or phlegmon on CT can be initially treated with intravenous antibiotics and percutaneous or transrectal drainage. If the patient's symptoms, white blood cell count, and fever resolve satisfactorily, therapy can be changed to oral antibiotics and the patient can be discharged home. Then, delayed (interval) appendectomy can be performed 4-8 weeks later.

According to the 2010 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline, the indications for laparoscopic appendectomy are identical to those for open appendectomy. The 2010 SAGES guideline lists the following conditions as suitable for laparoscopic appendectomy:

  • Uncomplicated appendicitis

  • Appendicitis in pediatric patients

  • Suspected appendicitis in pregnant women

For more on the treatment of appendicitis, read here.

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