Shown below is an algorithm depicting the diagnostic approach to appendicitis according to the guidelines by the Surgical Infection Society and the Infectious Diseases Society of America and the clinical policies of the American College of Emergency Physicians.[3][4]
❑ Ultrasound of the abdomen with or without ultrasound of the pelvis, or
❑ CT abdomen and pelvis with and/or without IV contrast, or
❑ MRI abdomen and pelvis with and/or without IV contrast, or
❑ X-ray abdomen
Shown below is an algorithm depicting the diagnostic approach to appendicitis according to the guidelines by the Surgical Infection Society and the Infectious Diseases Society of America and the clinical policies of the American College of Emergency Physicians.[3][4]
Imaging results
Negative
Inconclusive
Confirmatory
Non perforated appendicitis
Perforated appendicitis
Periappendiceal abscess
❑ Follow up for 24 hours until the resolution of signs and symptoms
❑ Follow up the patient
❑ Hospitalize the patient in case of high suspicion of appendicitis
❑ Administer antibiotics
❑ Appendectomy (laparoscopy or open surgery) as soon as it is feasible ❑ Consider non-operative management in case of marked improvement ❑ Administer narrow spectrum antibiotics for 24 hours
Shown below is a table summarizing the choice of antibiotics to be administered in appendicitis. Antibiotics treatment should be administered to all patients with appendicitis. Note that:
Mild to moderate cases include perforated appendicitis and abscess.
High risk or severe cases include severe physiological disturbance, advanced age and immunosuppression.[3]
Order imaging tests among all females with suspicion of appendicitis.
Before proceeding with a CT scan in females in the child bearing age, order a pregnancy test.
Order an ultrasound or magnetic resonance among pregnant females to avoid exposure to radiation. In case the previous tests were inconclusive and appendicitis is suspected, the next step in the management includes proceeding with either laparoscopy or limited CT scan.