May occur after >12 hours of progressive appendiceal inflammation.
Usually a consequence of a delay in seeking medical treatment.
Presents with more severe abdominal pain, high fever (>101°F [38.3°C]), localized tenderness, and decreased bowel sounds.
Large perforation of acutely inflamed appendix results in generalized peritonitis.
Presents with an acute abdomen (high fever, diffuse abdominal pain, generalized tenderness, and absent bowel sounds).
If the diagnosis is suspected as acute appendicitis, appendectomy can be performed. If diagnosis is in doubt, exploratory laparotomy should be performed through midline incision, and the appendix, if inflamed, should be removed.
Usually due to delay in medical treatment.
Presents with tender right lower quadrant mass. Ultrasonography or computed tomography scan will show a mass.
If the patient appears otherwise well, the initial management is conservative treatment with intravenous fluids and broad-spectrum antibiotics. If there is clinical improvement and the signs and symptoms are completely resolved, then there is no need for interval appendectomy. Interval appendectomy is performed after 6 weeks if the symptoms are not completely resolved.
In older patients, carcinoma should be excluded.
Usually occurs as a progression of the disease process, particularly after perforation.
Presents with tender right lower quadrant mass, swinging fever, and leukocytosis.
Ultrasonography or computed tomography (CT) scan will show the abscess.
Initial treatment includes intravenous antibiotics and CT-guided drainage of abscess.
The optimal management for appendicitis with phlegmon or abscess remains subject to debate. Latest evidence suggests that laparoscopic appendectomy is associated with fewer readmissions and fewer additional interventions than conservative management, provided advanced laparoscopic expertize is available. However, nonoperative management with antibiotics and, if available, percutaneous image-guided drainage is a reasonable alternative if the patient is stable and laparoscopic appendectomy is unavailable, although there is a lack of evidence for its use on a routine basis.
surgical wound infection
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