Skip to main content
WoMWeb of Medicine
SearchGraphHistory
General Surgery›Condition·Updated Apr 17, 2026·v1

Appendicitis

Acute appendicitis is the most frequent cause of the acute abdomen requiring surgery. Diagnosis relies on a combination of clinical signs (migratory pain, McBurney's tenderness) and cross-sectional imaging, with CT being the gold standard for adults and Ultrasound for children. While laparoscopic appendectomy is the primary treatment, selected uncomplicated cases may be managed with antibiotics. Special attention is required for the elderly and pregnant patients due to atypical presentations and higher complication risks.

High Evidence94 references·2,669 words·11 min read·v1
General SurgeryAcute AbdomenAppendectomyPediatric SurgeryEmergency Medicine

Quick Reference

RxDrug of choiceErtapenem 1 g IV daily or Ceftriaxone 1-2 g IV + Metronidazole 500 mg IV
AltAlternativesCefoxitin 2 g IV every 6 hours; Piperacillin/Tazobactam 3.375 g IV every 6 hours (for severe/complicated cases)
⊘AvoidAvoid laxatives or enemas in suspected appendicitis (risk of perforation); avoid gadolinium-based MRI contrast in pregnancy.
DxTest of choiceContrast-enhanced CT (Adults); Ultrasound (Children/Pregnancy)
ScKey scoreAlvarado Score or Appendicitis Inflammatory Response (AIR) Score
→When to referRefer to General Surgery immediately upon clinical suspicion or positive imaging findings.
Appendicitis is a surgical emergency where early diagnosis via imaging (CT or US) and laparoscopic intervention are key to preventing perforation and sepsis.
Acute appendicitis is the most common non-obstetric surgical emergency worldwide, characterized by the inflammation of the vermiform appendix. The condition typically results from a closed-loop obstruction of the appendiceal lumen, often by a fecalith or lymphoid hyperplasia, leading to increased intraluminal pressure, ischemia, and potential perforation. While the classic presentation involves migratory pain from the periumbilical region to the right lower quadrant, clinical manifestations vary significantly across different age groups and anatomical variants. Modern management has shifted toward an imaging-first diagnostic strategy to minimize negative appendectomy rates, with laparoscopic appendectomy remaining the definitive gold standard. However, non-operative management with antibiotics is increasingly considered for highly selected uncomplicated cases, provided there is no appendicolith present.

Overview and Recommendations

Background

  • •Recognize acute appendicitis as a progressive inflammatory process that begins with luminal obstruction, leading to mucus accumulation, bacterial overgrowth, and a rapid rise in intraluminal pressure. This mechanical distension triggers visceral afferent fibers in the T10 distribution, explaining the initial periumbilical pain.
  • •Identify common triggers for obstruction, including fecaliths, lymphoid hyperplasia (often following viral infections), and rare causes such as Appendico-Ileal Knotting (AIK)—also known as appendiceal tourniquet syndrome—where the appendix encircles the ileum.
  • •Consider genetic and systemic predispositions, such as , where thick viscid mucus increases the risk of impaction, or , which can involve the appendix through transmural inflammation.
  • •Understand the molecular progression where ischemia-modified albumin (IMA) serves as a marker for tissue necrosis; as intraluminal pressure exceeds venous pressure, venous and lymphatic drainage are impaired, eventually leading to arterial compromise and gangrene.
  • •Differentiate between simple (uncomplicated) appendicitis and complicated variants, which include perforation, phlegmon, or abscess formation, often seen in patients with delayed presentation or those at extremes of age.

Evaluation

  • •Suspect acute appendicitis in any patient presenting with new-onset abdominal pain, particularly if it follows the classic migratory pattern from the periumbilical area to the right lower quadrant (RLQ) over 12 to 48 hours.
  • •Ask about associated symptoms such as anorexia (the 'hamburger sign'), nausea, and vomiting, which typically occur after the onset of pain; the absence of anorexia should prompt consideration of alternative diagnoses.
  • •Examine the abdomen for localized tenderness at McBurney’s point (one-third the distance from the anterior superior iliac spine to the umbilicus) and assess for peritoneal signs like involuntary guarding and rebound tenderness.
  • •Perform specific maneuvers to localize the appendix: Rovsing’s sign (RLQ pain upon LLQ palpation), the Psoas sign (pain on hip extension suggesting a retrocecal appendix), and the Obturator sign (pain on internal rotation of the flexed hip suggesting a pelvic appendix).
  • •Utilize clinical risk stratification tools such as the or the Appendicitis Inflammatory Response (AIR) score to guide the necessity of imaging; patients with an Alvarado score < 4 are generally low risk.
  • •Order laboratory tests including a complete blood count (WBC count) and C-reactive protein (CRP); while non-specific, the combination of normal WBC and CRP has a high negative predictive value for appendicitis.
  • •Obtain a contrast-enhanced (CT) as the primary imaging modality in non-pregnant adults, as it provides superior visualization of the appendix and can identify alternative pathologies.
  • •Prioritize Ultrasound (US) as the first-line imaging modality in children and pregnant patients to avoid ionizing radiation; if US is inconclusive in these groups, proceed to MRI without gadolinium.
  • •Rule out mimics such as ectopic pregnancy (obtain a beta-hCG in all females of childbearing age), mesenteric adenitis, Meckel's diverticulitis, and which can involve the appendix and cause cyclical pain.
  • •Maintain a high index of suspicion for atypical presentations in the elderly (aged ≥65), who may present with vague symptoms and a 'quiet' abdomen despite advanced pathology or perforation.

Management

  • •Administer intravenous fluid resuscitation and keep the patient NPO (nothing by mouth) once the diagnosis is suspected or confirmed to prepare for potential surgical intervention.
  • •Perform laparoscopic appendectomy as the definitive gold standard treatment for both uncomplicated and complicated appendicitis, as it is associated with lower infection rates and faster recovery compared to open surgery.
  • •Initiate preoperative antibiotics to cover gram-negative and anaerobic organisms; for community-acquired mild-to-moderate cases, use Cefoxitin 2 g IV every 6 hours or Ertapenem 1 g IV daily.
  • •Utilize pediatric-specific antibiotic protocols for complicated cases: Ceftriaxone 50–80 mg/kg/day plus Metronidazole 30 mg/kg/day; if fever >38.5°C persists beyond 72 hours post-op, escalate to Piperacillin/Tazobactam 100 mg/kg every 8 hours.
  • •Consider non-operative management (NOM) with antibiotics alone for highly selected patients with uncomplicated appendicitis who wish to avoid surgery, but counsel them on the ~20-30% risk of recurrence within one year.
  • •Avoid NOM in patients with an appendicolith (calcified fecalith) visible on imaging, as this is associated with a high rate of antibiotic failure and rapid progression to perforation.
  • •Manage complicated appendicitis with a stable phlegmon or abscess (>3 cm) using initial NOM: administer IV antibiotics and arrange for percutaneous image-guided drainage rather than immediate surgery.
  • •Monitor for 'treatment-related fluctuation' or failure in NOM; if clinical status worsens or inflammatory markers rise despite antibiotics, proceed to urgent surgical intervention.
  • •Limit postoperative antibiotics to less than 24 hours for uncomplicated cases; for complicated cases with adequate source control, continue antibiotics for 4 to 7 days.
  • •Refer pregnant patients for immediate surgical consultation, as the risk of fetal loss and preterm labor increases significantly if the appendix perforates.
  • •Discharge patients when they are afebrile, tolerating a soft diet, and have adequate pain control with oral medications; routine post-discharge oral antibiotics are generally not required for uncomplicated cases.

Board Review — High Yield

  • •McBurney's Point — Located 1/3 the distance from the ASIS to the umbilicus; the site of maximal tenderness in classic appendicitis.
  • •Psoas Sign — Pain on passive extension of the right hip; indicates an inflamed appendix in the retrocecal position.
  • •Rovsing's Sign — Pain in the right lower quadrant elicited by palpation of the left lower quadrant; indicates peritoneal irritation.
  • •Appendicolith — A calcified fecalith seen on imaging; a strong predictor of failure for non-operative (antibiotic) management.
  • •Hamburger Sign — A clinical pearl where the patient's desire to eat their favorite food (e.g., a hamburger) makes appendicitis less likely (anorexia is highly sensitive).
  • •Subhepatic Appendicitis — A variant due to maldescent of the cecum; presents with RUQ pain mimicking cholecystitis.
  • •IMA (Ischemia-Modified Albumin) — A biochemical marker that rises during the ischemic phase of appendicitis before perforation occurs.
  • •Situs Inversus — A rare condition that can lead to left-sided appendicitis presentation.

Deep Dive — Evidence Details

References

  1. [1]

    Singh A, Pogorelić Z, Agrawal A et al.. “Utility of Ischemia-Modified Albumin as a Biomarker for Acute Appendicitis: A Systematic Review and Meta-Analysis.” Journal of clinical medicine (2023). PMID: 37685553 ↗

    L2aSR_OBSCited in: Pathophysiology
  2. [2]

    Reinisch A, Liese J, Padberg W et al.. “Robotic operations in urgent general surgery: a systematic review.” Journal of robotic surgery (2023). PMID: 35727485 ↗

    L2aSR_OBSCited in: Pathophysiology
  3. [3]

    Singh P, Singh SP, Verma AK et al.. “A Systematic Review of Abdominal Imaging Findings in COVID-19 Patients.” Visceral medicine (2021). PMID: 34580634 ↗

    L2aSR_OBSCited in: Pathophysiology
  4. [4]

    Quaresma AB, Miranda EF, Kotze PG. “MANAGEMENT OF ILEOCECAL CROHN'S DISEASE DURING SURGICAL TREATMENT FOR ACUTE APPENDICITIS: A SYSTEMATIC REVIEW.” Arquivos de gastroenterologia (2021). PMID: 34909865 ↗

    L2aSR_OBSCited in: Pathophysiology
  5. [5]

    Caliskan O, Ozkan BN, Unlu MT et al.. “Ischemia-Modified Albumin and Oxidative Stress Marker in Acute Appendicitis: A Prospective Study.” The Journal of surgical research (2025). PMID: 40381390 ↗

    L2bCOHORTCited in: Pathophysiology
  6. [6]

    Ley D, Turck D. “Digestive outcomes in Cystic fibrosis.” Best practice & research. Clinical gastroenterology (2022). PMID: 35331400 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology
  7. [7]

    Kärkkäinen JM. “Acute Mesenteric Ischemia: A Challenge for the Acute Care Surgeon.” Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society (2021). PMID: 33866891 ↗

    L5REVIEW_NARRATIVECited in: Pathophysiology
  8. [8]

    Lin J, Liu X, Li Y et al.. “Testicular torsion after laparoscopic appendectomy: salvage by spermatic cord heparin flush and testicular decompression - a case report and literature review.” BMC pediatrics (2025). PMID: 40604587 ↗

    L4CASE_REPORTCited in: Pathophysiology
  9. [9]

    Harada T, Watari T, Watanuki S et al.. “Preventable diagnostic errors of lower gastrointestinal perforation: a secondary analysis of a large-scale multicenter retrospective study.” International journal of emergency medicine (2024). PMID: 39702011 ↗

    L2bCOHORTCited in: Pathophysiology
  10. [10]

    Bhargav P, Tiwari AK, Nargesh SS et al.. “Appendico-Ileal Knotting (Appendiceal Tourniquet Syndrome): A Systematic Review and Clinicopathological Classification.” Cureus (2026). PMID: 41777962 ↗

    L2aSR_OBSCited in: Pathophysiology
  11. [11]

    Dibekoğlu C. “Does the length matter in acute appendicitis for the perforation risk?: A retrospective cohort study.” Medicine (2022). PMID: 36482564 ↗

    L2bCOHORTCited in: Pathophysiology
  12. [12]

    Coutureau J, Millet I, Taourel P. “CT of acute abdomen in the elderly.” Insights into imaging (2025). PMID: 40335795 ↗

    L5OTHERCited in: Pathophysiology
  13. [13]

    Coccolini F, Brogi E, Ceresoli M et al.. “Epidemiological analysis of intra-abdominal infections in Italy from the Italian register of complicated intra-abdominal infections-the IRIS study: a prospective observational nationwide study.” World journal of emergency surgery : WJES (2025). PMID: 40097999 ↗

    L5OTHERCited in: Pathophysiology
  14. [14]

    Sermonesi G, Tian BWCA, Vallicelli C et al.. “Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma.” World journal of emergency surgery : WJES (2023). PMID: 38066631 ↗

    L5OTHERCited in: Pathophysiology
  15. [15]

    O'Meara L, Zhang A, Baum JN et al.. “Anticoagulation in emergency general surgery: Who bleeds more? The EAST multicenter trials ACES study.” The journal of trauma and acute care surgery (2023). PMID: 37349868 ↗

    L5OTHERCited in: Pathophysiology
  16. [16]

    Guttman MP, Tillmann BW, Nathens AB et al.. “Long-term survival in high-risk older adults following emergency general surgery admission.” The journal of trauma and acute care surgery (2021). PMID: 34252059 ↗

    L5OTHERCited in: Pathophysiology
  17. [17]

    Koninckx CR, Donat E, Benninga MA et al.. “The Use of Fecal Calprotectin Testing in Paediatric Disorders: A Position Paper of the European Society for Paediatric Gastroenterology and Nutrition Gastroenterology Committee.” Journal of pediatric gastroenterology and nutrition (2021). PMID: 33716293 ↗

    L5OTHERCited in: Pathophysiology
  18. [18]

    Guttman MP, Tillmann BW, Nathens AB et al.. “Alive and at home: Five-year outcomes in older adults following emergency general surgery.” The journal of trauma and acute care surgery (2021). PMID: 33502146 ↗

    L5OTHERCited in: Pathophysiology
  19. [19]

    Elaskri H, Ben Abid S, Oueslati A et al.. “Cocaine-associated non-occlusive ischemic colitis mimicking appendicitis in a young woman: a case report.” Future science OA (2025). PMID: 41071079 ↗

    L4CASE_REPORTCited in: Pathophysiology
  20. [20]

    Horibe A, Funasaka J, Hiroshima K et al.. “Epiploic appendagitis on the vermiform appendix is often misdiagnosed as acute appendicitis.” Emergency radiology (2025). PMID: 39661268 ↗

    L4CASE_REPORTCited in: Pathophysiology
  21. [21]

    Chen L, Feng Y, Liu Y et al.. “Digital cholangioscope-assisted endoscopic direct-vision appendicitis therapy versus laparoscopic appendectomy for chronic appendicitis: a multicenter retrospective cohort study.” Therapeutic advances in gastroenterology (2026). PMID: 41732326 ↗

    L2bCOHORTCited in: Clinical Features and Variants
  22. [22]

    Nezhat C, Najmi Z, Mirzaie M et al.. “Selective Appendectomy in Patients Undergoing Minimally Invasive Surgery for Endometriosis: A Retrospective Cohort Study.” Journal of clinical medicine (2025). PMID: 41156147 ↗

    L2bCOHORTCited in: Clinical Features and Variants
  23. [23]

    Jiang YF, Li XZ, Wang PA et al.. “Case Report: Appendiceal neurofibroma associated with neurofibromatosis type 1: a rare case and systematic review of the literature.” Frontiers in surgery (2026). PMID: 41971055 ↗

    L2aSR_OBSCited in: Clinical Features and Variants
  24. [24]

    Akbulut S, Kucukakcali Z, Colak C. “Artificial intelligence in acute appendicitis: A comprehensive review of machine learning and deep learning applications.” World journal of gastroenterology (2025). PMID: 41358178 ↗

    L5REVIEW_NARRATIVECited in: Clinical Features and Variants
  25. [25]

    Shivalingam Vanaraj NA, G V V, Vijayakumar K et al.. “Subhepatic Appendicitis: A Systematic Review of Clinical Presentation, Diagnostic Challenges, and Surgical Management.” Cureus (2025). PMID: 41466917 ↗

    L2aSR_OBSCited in: Clinical Features and Variants
  26. [26]

    Zheng J, Sun Y, Xu B. “Endoscopic diagnosis of appendiceal hemorrhage with a disposable imaging catheter (EyeMax): a case report.” Frontiers in medicine (2026). PMID: 41788716 ↗

    L4CASE_REPORTCited in: Clinical Features and Variants
  27. [27]

    Li D. “Emergency surgical conditions in geriatric patients: current research landscape.” International journal of emergency medicine (2025). PMID: 41462071 ↗

    L5REVIEW_NARRATIVECited in: Clinical Features and Variants
  28. [28]

    Aslan F, Binici S, Beger B et al.. “Acute appendicitis in geriatric population: a clinical and prognostic comparison of surgical intervention and conservative management.” BMC geriatrics (2026). PMID: 41987071 ↗

    L5OTHERCited in: Clinical Features and Variants
  29. [29]

    Calışkan YK, Başak F, Erdem O. “Can AI safely choose antibiotics over the knife? A STROBE-guided benchmark of GPT-4, GPT-5, and Gemini for non-operative acute appendicitis management.” International journal of medical informatics (2026). PMID: 41831386 ↗

    L5OTHERCited in: Clinical Features and Variants
  30. [30]

    Sahin E, Tuncer A, Kayaalp C et al.. “Small Intestine and Vermiform Appendix Lengths in Healthy Adults: Intraoperative Morphometric Data from a Living Donor Cohort.” Journal of clinical medicine (2026). PMID: 41827164 ↗

    L5OTHERCited in: Clinical Features and Variants
  31. [31]

    Li X, Lin L, Yu C et al.. “Case Report: Diagnostic challenges in pediatric appendicitis: a case of perforated appendicitis with secondary hepatic abscess.” Frontiers in pediatrics (2026). PMID: 41798284 ↗

    L4CASE_REPORTCited in: Clinical Features and Variants
  32. [32]

    Vorel ES. “Point-of-Care Ultrasound Identification of Motile Enterobius vermicularis in the Appendix of a Toddler: The Youngest Reported Case and Successful Nonoperative Management of Early Appendicitis.” Pediatric emergency care (2026). PMID: 41622431 ↗

    L4CASE_REPORTCited in: Clinical Features and Variants
  33. [33]

    Yao H, Ma P, Gao R et al.. “Case Report: Midgut malrotation presenting as left-sided appendicitis with secondary omental torsion: a diagnostic challenge in a child.” Frontiers in pediatrics (2025). PMID: 41602878 ↗

    L4CASE_REPORTCited in: Clinical Features and Variants
  34. [34]

    Didžiokaitė G, Kuznecovaitė A, Šileikis A et al.. “Delayed Diagnosis of Acute Appendicitis in the Third Trimester of Pregnancy: Diagnostic Pitfalls, Multisurgical Management, and a Prolonged Postoperative Course-A Multidisciplinary Case Report.” Diagnostics (Basel, Switzerland) (2025). PMID: 41153265 ↗

    L4CASE_REPORTCited in: Clinical Features and Variants
  35. [35]

    Hayajneh R, Ghazal K, Nakib G. “Atypical presentation of immunoglobulin A vasculitis mimicking acute appendicitis in a pediatric patient: a case report.” Future science OA (2025). PMID: 40961422 ↗

    L4CASE_REPORTCited in: Clinical Features and Variants
  36. [36]

    Podda M, Ceresoli M, De Simone B et al.. “Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines.” JAMA surgery (2026). PMID: 41604201 ↗

    L1cGUIDELINECited in: Special Populations, Guidelines and Resources
  37. [37]

    Arredondo Montero J, Rico-Jiménez M. “Post-discharge oral home antibiotic use in complicated pediatric appendicitis: a systematic review and meta-analysis.” World journal of pediatrics : WJP (2026). PMID: 41591702 ↗

    L2aSR_OBSCited in: Special Populations
  38. [38]

    Tustumi F, Sposito Ribeiro Baltazar LF, Correa LH et al.. “Social Determinants of Health in Pediatric Appendicitis: A Systematic Review and Meta-analysis.” The Journal of surgical research (2025). PMID: 41317594 ↗

    L2aSR_OBSCited in: Special Populations
  39. [39]

    Zouari M, Belhajmansour M, Hbaieb M et al.. “Clinical and Inflammatory Predictors of False-Negative Ultrasound in Children With Suspected Appendicitis: A Prospective Cohort Study.” World journal of surgery (2026). PMID: 41731339 ↗

    L2bCOHORTCited in: Special Populations
  40. [40]

    Charlier C, Vijayaratnam S, Jeanton-Seybel C et al.. “Specificities of pediatric listeriosis beyond the neonatal period: A national prospective study.” Med (New York, N.Y.) (2026). PMID: 41605203 ↗

    L2bCOHORTCited in: Special Populations
  41. [41]

    Permyakova NV, Reading IC, Bridget Y et al.. “The clinical and cost effectiveness of a conservative treatment pathway compared to appendicectomy in children with uncomplicated acute appendicitis: study protocol for a randomised controlled multi-centre open-label parallel-group non-inferiority trial (CONTRACT 2 trial) in the United Kingdom (UK).” Trials (2025). PMID: 41345705 ↗

    L2bTRIAL_NONRANDOMCited in: Special Populations
  42. [42]

    Akkoyun I, Unuvar BS, Sezer HK et al.. “Effectiveness of Kinesio Taping after Open Appendectomy in Children.” Journal of the College of Physicians and Surgeons--Pakistan : JCPSP (2026). PMID: 41792069 ↗

    L1bRCTCited in: Special Populations
  43. [43]

    Saqib T. “A Retrospective Study of Acute Appendicitis-Related Mortality Among Older Adults in the United States: Regional and Demographic Patterns From 1999 to 2020.” Australasian journal on ageing (2026). PMID: 41857783 ↗

    L2bCOHORTCited in: Special Populations
  44. [44]

    Höpner LK, Marschall E, Schindler P et al.. “Dermatological and gastrointestinal adverse reactions in ocrelizumab treated patients with multiple sclerosis: a case series.” Frontiers in immunology (2026). PMID: 41878428 ↗

    L4CASE_REPORTCited in: Special Populations
  45. [45]

    Chen L, Chen Y, Lian Y et al.. “Eggerthella lenta: A rare cause of septic shock and sepsis after Fournier's gangrene.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2026). PMID: 41352755 ↗

    L4CASE_REPORTCited in: Special Populations
  46. [46]

    Karacan E, Kayili HM. “Machine learning-based diagnostic modeling for differentiating lymphoid hyperplasia from acute appendicitis using laboratory biomarkers.” American journal of surgery (2026). PMID: 41855732 ↗

    L5OTHERCited in: Special Populations
  47. [47]

    Andresson G, Kristínardóttir ÁS. “The Time Course of Perforation and Abscess Formation in Appendicitis.” World journal of surgery (2026). PMID: 41831204 ↗

    L5OTHERCited in: Special Populations
  48. [48]

    Özel HP, Ertenlice A, Er S et al.. “Epidemiology and histopathological spectrum of appendiceal pathologies in 40.286 adults: a multicenter study from Turkey (2017-2025).” European journal of trauma and emergency surgery : official publication of the European Trauma Society (2026). PMID: 41770340 ↗

    L5OTHERCited in: Special Populations
  49. [49]

    Gowda T, Aguirre N, Mohamed M et al.. “Incidence and Predictors of Neoplastic Diagnosis in Patients with a Clinically Abnormal Appendix.” Annals of surgical oncology (2026). PMID: 41721166 ↗

    L5OTHERCited in: Special Populations
  50. [50]

    Xu J, Zhu L, Liu W et al.. “Feasibility study of fast T2-weighted imaging with deep-learning reconstruction in volunteers and emergency patients with acute abdomen.” European journal of radiology (2026). PMID: 41616758 ↗

    L5OTHERCited in: Special Populations
  51. [51]

    Carvalho N, Almeida JS, Carolino E et al.. “Characterization of Th2 Serum Immune Response in Acute Appendicitis.” International journal of molecular sciences (2026). PMID: 41596388 ↗

    L5OTHERCited in: Special Populations
  52. [52]

    Cipolletta E, Zverkova Sandström T, Rozza D et al.. “Treat-to-Target Urate-Lowering Treatment and Cardiovascular Outcomes in Patients With Gout.” JAMA internal medicine (2026). PMID: 41587055 ↗

    L5OTHERCited in: Special Populations
  53. [53]

    Liao S, Li Y, Tang H et al.. “Lightweight interpretable AI model using multiple blood parameters for emergency diagnosis of acute appendicitis.” The American journal of emergency medicine (2026). PMID: 41570492 ↗

    L5OTHERCited in: Special Populations
  54. [54]

    Foroutani L, Wang JJ, Kiran S et al.. “True Incidence of Appendiceal Neoplasms in Patients Presenting with Complicated Appendicitis: A Call for a Revised Management Algorithm.” Annals of surgical oncology (2026). PMID: 41524877 ↗

    L5OTHERCited in: Special Populations
  55. [55]

    Ingram MC. “Invited commentary on: Family decision-making during access to surgical care for children: A qualitative analysis and conceptual framework.” Journal of pediatric surgery (2026). PMID: 41421547 ↗

    L5OTHERCited in: Special Populations
  56. [56]

    Turpin AG, Asti L, Lutz C et al.. “Is Appendiceal Cancer a Risk of Nonoperative Management of Pediatric Uncomplicated Appendicitis?” The Journal of surgical research (2026). PMID: 41380223 ↗

    L5OTHERCited in: Special Populations
  57. [57]

    Studer E, Flament-Viricel C, Calinescu AM et al.. “Pediatric complicated appendicitis: Results of a standardized antibiotic protocol in a tertiary center.” Journal of pediatric surgery (2026). PMID: 41371438 ↗

    L5OTHERCited in: Special Populations
  58. [58]

    Lin AM, Meckmongkol T, Fall F et al.. “Implementing pediatric appendicitis pathways across multiple hospitals: A quality improvement project.” Journal of pediatric surgery (2026). PMID: 41352416 ↗

    L5OTHERCited in: Special Populations
  59. [59]

    Schrempf MC, Schiele S, Anthuber M et al.. “Safety of In-Hospital Delay of Appendectomy in Elderly Patients-A Retrospective Analysis of 525 Consecutive Patients Aged 65 and Older Undergoing Surgery for Suspected Appendicitis.” World journal of surgery (2026). PMID: 41351214 ↗

    L5OTHERCited in: Special Populations
  60. [60]

    Arda Y, Brackin RB, Nzenwa IC et al.. “Sex-Based Disparities in Acute Appendicitis: A Nationwide Analysis.” The Journal of surgical research (2025). PMID: 41337808 ↗

    L5OTHERCited in: Special Populations
  61. [61]

    Hall B, Rhoads M, Happ M et al.. “Family decision-making during access to surgical care for children: A qualitative analysis and conceptual framework.” Journal of pediatric surgery (2026). PMID: 41317954 ↗

    L5OTHERCited in: Special Populations
  62. [62]

    Ağ O, Kutluer N, Öğüt MZ et al.. “The Importance of Preoperatively Calculated Halp Score in Differentiating Complicated Acute Appendicitis in Patients With Acute Appendicitis.” World journal of surgery (2026). PMID: 41291390 ↗

    L5OTHERCited in: Special Populations
  63. [63]

    Clayton J, Krews J, Fouchi G et al.. “An unusual subhepatic cecum identified during cadaveric dissection: relevance for clinical diagnosis and anatomy education.” Surgical and radiologic anatomy : SRA (2026). PMID: 41649580 ↗

    L4CASE_REPORTCited in: Special Populations
  64. [64]

    Purnomo E, Pambudi BS, Nabilah AN. “Comparative outcomes of single incision laparoscopy versus conventional laparoscopy in paediatric population: a meta analysis.” The Medical journal of Malaysia (2025). PMID: 41451717 ↗

    L2aSR_OBSCited in: Special Populations
  65. [65]

    Yi T, Song Z, Zhao H et al.. “Peri-appendiceal inflammation is associated with appendiceal orifice stenosis and appendiceal body thickening in ulcerative colitis: A case-control study.” The Journal of international medical research (2025). PMID: 41397450 ↗

    L3bCASE_CONTROLCited in: Special Populations
  66. [66]

    Kumar SS, Collings AT, Lamm R et al.. “SAGES guideline for the diagnosis and treatment of appendicitis.” Surgical endoscopy (2024). PMID: 38740595 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  67. [67]

    Solomkin JS, Mazuski JE, Bradley JS et al.. “Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2010). PMID: 20034345 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  68. [68]

    Kumar SS, Collings AT, Wunker C et al.. “SAGES guidelines for the use of laparoscopy during pregnancy.” Surgical endoscopy (2024). PMID: 38700549 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  69. [69]

    Gorter RR, Eker HH, Gorter-Stam MA et al.. “Diagnosis and management of acute appendicitis. EAES consensus development conference 2015.” Surgical endoscopy (2016). PMID: 27660247 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  70. [70]

    Boyle A, Huo B, Sylla P et al.. “Large language model-generated clinical practice guideline for appendicitis.” Surgical endoscopy (2025). PMID: 40251310 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  71. [71]

    Bonomo RA, Tamma PD, Abrahamian FM et al.. “2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Diagnostic Imaging of Suspected Acute Appendicitis in Adults, Children, and Pregnant People.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (2024). PMID: 38963819 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  72. [72]

    Koberlein GC, Trout AT, Rigsby CK et al.. “ACR Appropriateness Criteria® Suspected Appendicitis-Child.” Journal of the American College of Radiology : JACR (2019). PMID: 31054752 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  73. [73]

    Salö M, Tiselius C, Rosemar A et al.. “Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children.” BJS open (2025). PMID: 40203150 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  74. [74]

    Antoniou SA, Mavridis D, Kontouli KM et al.. “EAES rapid guideline: appendicitis in the elderly.” Surgical endoscopy (2021). PMID: 33999255 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  75. [75]

    Fugazzola P, Ceresoli M, Agnoletti V et al.. “The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition).” World journal of emergency surgery : WJES (2020). PMID: 32156296 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  76. [76]

    Adamina M, Andreou A, Arezzo A et al.. “EAES rapid guideline: systematic review, meta-analysis, GRADE assessment, and evidence-informed European recommendations on appendicitis in pregnancy.” Surgical endoscopy (2022). PMID: 36307599 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  77. [77]

    Garcia EM, Camacho MA, Karolyi DR et al.. “ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis.” Journal of the American College of Radiology : JACR (2018). PMID: 30392606 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  78. [78]

    Kumar SS, Calabrese EC, Slater BJ et al.. “SAGES guidelines update to laparoscopy in the era of COVID-19.” Surgical endoscopy (2025). PMID: 39930124 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  79. [79]

    Coccolini F, Improta M, Sartelli M et al.. “Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines.” World journal of emergency surgery : WJES (2021). PMID: 34372902 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  80. [80]

    Chen MM, Coakley FV, Kaimal A et al.. “Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation.” Obstetrics and gynecology (2008). PMID: 18669732 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  81. [81]

    Kambadakone AR, Santillan CS, Kim DH et al.. “ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update.” Journal of the American College of Radiology : JACR (2022). PMID: 36436969 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  82. [82]

    Rushing A, Bugaev N, Jones C et al.. “Management of acute appendicitis in adults: A practice management guideline from the Eastern Association for the Surgery of Trauma.” The journal of trauma and acute care surgery (2019). PMID: 30908453 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  83. [83]

    Perrone G, Sartelli M, Mario G et al.. “Management of intra-abdominal-infections: 2017 World Society of Emergency Surgery guidelines summary focused on remote areas and low-income nations.” International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (2020). PMID: 32739433 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  84. [84]

    Howell JM, Eddy OL, Lukens TW et al.. “Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected appendicitis.” Annals of emergency medicine (2010). PMID: 20116016 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  85. [85]

    Brook OR, Dadour JR, Robbins JB et al.. “ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group: 2023 Update.” Journal of the American College of Radiology : JACR (2024). PMID: 38823952 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  86. [86]

    Nadler EP, Gaines BA. “The Surgical Infection Society guidelines on antimicrobial therapy for children with appendicitis.” Surgical infections (2008). PMID: 18363471 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  87. [87]

    Vettoretto N, Gobbi S, Corradi A et al.. “Consensus conference on laparoscopic appendectomy: development of guidelines.” Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland (2011). PMID: 21651696 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  88. [88]

    Dietrich CF, Hollerweger A, Dirks K et al.. “EFSUMB Gastrointestinal Ultrasound (GIUS) Task Force Group: Celiac sprue and other rare gastrointestinal diseases ultrasound features.” Medical ultrasonography (2019). PMID: 31476211 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  89. [89]

    Collard MK, Christou N, Lakkis Z et al.. “Adult appendicitis: Clinical practice guidelines from the French Society of Digestive Surgery and the Society of Abdominal and Digestive Imaging.” Journal of visceral surgery (2021). PMID: 33419677 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  90. [90]

    Solomkin JS, Mazuski JE, Bradley JS et al.. “Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.” Surgical infections (2010). PMID: 20163262 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  91. [91]

    Bednarczuk T, Bolanowski M, Zemczak A et al.. “Neuroendocrine neoplasms of the small intestine and appendix - management guidelines (recommended by the Polish Network of Neuroendocrine Tumours).” Endokrynologia Polska (2017). PMID: 28540974 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  92. [92]

    Charvériat A, Fritel X. “[Diagnosis of pelvic inflammatory disease: Clinical, paraclinical, imaging and laparoscopy criteria. CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines].” Gynecologie, obstetrique, fertilite & senologie (2019). PMID: 30878687 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  93. [93]

    Bakker OJ, Go PM, Puylaert JB et al.. “[Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended].” Nederlands tijdschrift voor geneeskunde (2010). PMID: 21262032 ↗

    L1cGUIDELINECited in: Guidelines and Resources
  94. [94]

    Bakker OJ, Go PM, Puylaert JB et al.. “[Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended].” Nederlands tijdschrift voor geneeskunde (2010). PMID: 20482926 ↗

    L1cGUIDELINECited in: Guidelines and Resources

Revision History

All updates applied to this page

Loading revisions…