• Kristen T. Crowell
  • Evangelos MessarisEmail author


Acute appendicitis is suspected in patients with acute abdominal pain which typically migrates from the periumbilical region to the right lower quadrant, associated with fever, nausea, and anorexia. Leukocytosis and rebound tenderness in the right lower quadrant are indicative of acute appendicitis. CT scan is indicated in female patients with high suspicion of the disease and in patients in which the diagnosis is suspicious but the history, exam, and WBC are not all supportive of acute appendicitis. If acute appendicitis is suspected, laparoscopic appendectomy is the standard of care. Perforated appendicitis is treated either nonoperatively if an abscess is present with IV antibiotics, drainage of abscess, and potentially an interval appendectomy or by laparoscopic appendectomy if free perforation occurs.


Abdominal pain Acute abdomen Acute appendicitis Right lower quadrant pain Laparoscopic appendectomy 


  1. 1.
    Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979–90.CrossRefGoogle Scholar
  2. 2.
    Scott AJ, Mason SE, Arunakirinathan M, Reissis Y, Kinross JM, Smith JJ. Risk stratification by the appendicitis inflammatory response score to guide decision-making in patients with suspected appendicitis. Br J Surg. 2015;102(5):563–72.CrossRefGoogle Scholar
  3. 3.
    Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338(3):141–6.CrossRefGoogle Scholar
  4. 4.
    Long KH, Bannon MP, Zietlow SP, Helgeson ER, Harmsen WS, Smith CD, et al. A prospective randomized comparison of laparoscopic appendectomy with open appendectomy: clinical and economic analyses. Surgery. 2001;129(4):390–400.CrossRefGoogle Scholar
  5. 5.
    Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246(5):741–8.CrossRefGoogle Scholar
  6. 6.
    Mentula P, Sammalkorpi H, Leppaniemi A. Laparoscopic surgery or conservative treatment for appendiceal abscess in adults? A randomized controlled trial. Ann Surg. 2015;262(2):237–42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Division of Colon and Rectal SurgeryBeth Israel Medical Center, Harvard Medical CenterBostonUSA

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