← Diagnosis and Management Guides
Acute Appendicitis
Key considerations: Perforated appendicitis, Appendiceal abscess, Ectopic pregnancy
Cannot miss
- Perforated appendicitis
- Appendiceal abscess
- Ectopic pregnancy
Likely diagnoses
- Acute appendicitis
- Mesenteric lymphadenitis
- Ovarian pathology
- Gastroenteritis
Red flags
- Peritoneal signs
- Fever >38.5
- Free air on imaging
Workup
- history: Periumbilical pain migrating to RLQ, anorexia, nausea, fever; exam: McBurney point tenderness, Rovsing sign, psoas sign, obturator sign; labs: CBC (WBC), CRP, urinalysis, pregnancy test; imaging: CT abdomen/pelvis with IV contrast (adults); Ultrasound first in children and pregnant patients; bedside: RLQ point-of-care ultrasound
Management
- immediate: NPO, IV fluids, pain management (opioids do NOT mask exam findings); general: Laparoscopic appendectomy — gold standard; Antibiotics-first approach acceptable for uncomplicated cases (CODA trial); Complicated (perforated with abscess): antibiotics ± percutaneous drainage, interval appendectomy
Disposition
- admit: All confirmed appendicitis; discharge: Only after appendectomy with good recovery; consults: Surgery
Clinical pearls
- Providing analgesia does NOT mask peritoneal findings — do not withhold pain medication
- CT sensitivity >95% in adults — ultrasound is operator dependent but preferred in peds/pregnancy
Source and review
- SAGES Appendicitis Guidelines 2021. Last reviewed: 2024-11-01