The goal of therapy of acute appendicitis is early diagnosis and prompt operative intervention. However, this goal is not always easily accomplished since many patients do not seek medical attention in a timely manner and the diagnosis of appendicitis can be difficult . Many surgeons use an aggressive approach, accepting a certain number of negative appendectomies, traditionally 15 percent, although the use of imaging studies appears to have reduced the negative appendectomy rate to less than 10 percent .
The management of appendicitis in adults will be reviewed here. The diagnosis and differential diagnosis of appendicitis, appendicitis in pregnancy, and the diagnosis and differential diagnosis of abdominal pain in general are discussed separately. (See "Acute appendicitis in adults: Clinical manifestations and differential diagnosis" and "Acute appendicitis in pregnancy" and "Diagnostic approach to abdominal pain in adults" and "Differential diagnosis of abdominal pain in adults".)
The great majority of patients with acute appendicitis are treated surgically and an appendectomy remains the gold standard of care. However, at least in theory, nonoperative management of nonperforated acute appendicitis may parallel similar management of acute, nonperforated diverticulitis. (See "Nonoperative management of acute uncomplicated diverticulitis", section on 'Outcomes'.).
A retrospective review of the California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge database that included 231,678 patients with a diagnosis of acute appendicitis (without peritonitis, rupture, or perforation) found patients managed nonoperatively with intravenous broad spectrum antibiotics (n = 3236) had a treatment failure rate of 5.9 percent, and a recurrence rate of 4.4 percent . Mean time to treatment failure or recurrence was 5.9 days and 1.9 years, respectively. Mortality rates and costs were similar; however, the length of stay was significantly longer for nonoperative management compared with operative management (2.1 versus 3.2 days).
The cumulative risk of perforation for nonoperative management of uncomplicated appendicitis was 3.2 percent.