Suggested algorithm for the nonoperative management of acute uncomplicated appendicitis

Diagnosis of uncomplicated appendicitis suspected

Treat based on actual diagnosis

CT scan for confirmation of diagnosis

Appendicitis not confirmed

Uncomplicated appendicitis confirmed

End

Appendectomy

Good operative candidate

Poor operative candidate

Nonoperative treatment with antibiotics

Pt improves

Pt worsens

Medical optimization, appendectomy

Continued expectant management

Discharge, monitor for recurrence, outpatient colonoscopy

Asymptomatic

Recurrence

Medical optimization, appendectomy

Peritonitis sepsis

No peritonitis, stable

Continue IV antibiotics till resolved

CT-guided drainage

Repeat CT

Abscess

Phlegmon

Discharge, outpatient colonoscopy