A 55-year-old man has CT evidence of complicated appendicitis with a contained abscess in the RLQ. He is mildly tachycardic, afebrile, and normotensive with focal RLQ tenderness but no peritonitis. What is the optimal approach to this patient?A) Immediate laparotomy
Conservative management of the physiologically stable patient with complicated appendicitis has been shown to be associated with fewer overall complications, fewer bowel obstructions, fewer intra-abdominal abscesses, and fewer reoperations. While patients with peritonitis or hemodynamic instability should proceed to the operating room, conservative management of more stable patients with complicated appendicitis is favored. This may not necessarily be true in the pediatric population, however, as two prospective randomized trials in children demonstrate equivalent or superior outcomes with early operative intervention.