Akut Apandisit: Etiyopatogenezden Güncel Tedavi Algoritmalarına Kapsamlı Bir Bakış
Özet
Akut apandisit (AA), dünya genelinde acil abdominal cerrahi girişimlerin en sık nedenidir ve günümüzde apendektomi halen en yaygın intraabdominal cerrahi müdahale olma özelliğini korumaktadır. Geleneksel olarak progresif bir tablo olarak kabul edilse de güncel veriler, hastalığın "komplike olmayan" ve "komplike" olmak üzere iki farklı patofizyolojik seyir izleyebileceğini göstermektedir. Bu derleme, Dünya Acil Cerrahi Derneği (WSES) 2020 ve Amerika İnfeksiyon Hastalıkları Derneği (IDSA) 2024 kılavuzları ışığında, AA'nın etiyopatogenezini, klinik tanı araçlarını ve güncel tedavi algoritmalarını incelemektedir. Hastalık insidansı 10-30 yaş grubunda pik yapmakta olup, erkeklerde yaşam boyu risk daha yüksektir (%8.6'ya karşılık %6.7). Tanısal süreçte klasik fizik muayene bulgularının (McBurney hassasiyeti, Rovsing, Psoas vb.) yanı sıra AIR ve RIPASA gibi klinik skorlama sistemlerinin kullanımı, tanısal doğruluğu artırarak negatif apendektomi oranlarını minimize etmektedir. Görüntülemede yetişkinler için düşük doz intravenöz kontrastlı bilgisayarlı tomografi altın standart iken; çocuk ve gebe popülasyonda ultrasonografi ve manyetik rezonans görüntüleme öncelikli tercihtir. Tedavi yönetiminde laparoskopik apendektomi, düşük komplikasyon oranları ile altın standart konumundadır. Bununla birlikte, seçilmiş komplike olmayan vakalarda antibiyotik temelli non-operatif yönetim, nüks riskleri (%40 seviyelerinde) hasta ile paylaşılmak kaydıyla güvenli bir alternatif sunmaktadır. Sonuç olarak, modern AA yönetimi; doğru radyolojik evreleme ve hasta bazlı, multidisipliner bir yaklaşımı gerekli kılmaktadır.
Acute appendicitis (AA) is the leading cause of emergency abdominal surgical interventions worldwide, and appendectomy remains the most frequently performed intra-abdominal surgical procedure today. Although traditionally regarded as a progressive condition, current evidence suggests that the disease can follow two distinct pathophysiological courses: "uncomplicated" and "complicated." In light of the 2020 World Society of Emergency Surgery (WSES) and 2024 Infectious Diseases Society of America (IDSA) guidelines, this chapter examines the etiopathogenesis, clinical diagnostic tools, and contemporary treatment algorithms of AA.
The incidence of the disease peaks within the 10–30 age group, with a higher lifetime risk observed in males compared to females (8.6% vs. 6.7%). In the diagnostic process, utilizing clinical scoring systems such as the Appendicitis Inflammatory Response (AIR) score and the RIPASA score, alongside classic physical examination findings (e.g., McBurney, Rovsing, and Psoas signs), enhances diagnostic accuracy and minimizes negative appendectomy rates. Regarding imaging modalities, low-dose intravenous contrast-enhanced computed tomography is the gold standard for adults; however, ultrasonography and magnetic resonance imaging are the primary preferences in pediatric and pregnant populations. Laparoscopic appendectomy remains the gold standard in treatment management due to its low complication rates. Nevertheless, antibiotic-based non-operative management offers a safe alternative in selected uncomplicated cases, provided that recurrence risks (approximately 40%) are communicated to the patient through shared decision-making. In conclusion, modern AA management necessitates accurate radiological staging and a patient-centered, multidisciplinary approach.
Referanslar
Lotfollahzadeh S, Lopez RA, Deppen JG. Appendicitis. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
di Saverio S, Podda M, de Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery : WJES. 2020;15.
Bonomo RA, Tamma PD, Abrahamian FM, Bessesen M, Chow AW, Dellinger EP, 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. 2024;79(Supplement_3):S94-S103.
Kumar SS, Collings AT, Lamm R, Haskins IN, Scholz S, Nepal P, et al. SAGES guideline for the diagnosis and treatment of appendicitis. Surg Endosc. 2024;38(6):2974-94.
Téoule P, Laffolie J, Rolle U, Reissfelder C. Acute Appendicitis in Childhood and Adulthood. Dtsch Arztebl Int. 2020;117(45):764-74.
Yang Y, Guo C, Gu Z, Hua J, Zhang J, Qian S, et al. The Global Burden of Appendicitis in 204 Countries and Territories from 1990 to 2019. Clin Epidemiol. 2022;14:1487-99.
Lapsa S, Ozolins A, Strumfa I, Gardovskis J. Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem. Geriatrics (Basel). 2021;6(3).
Nabi R, Rath S, Ahmad Chaudhry SA, Rajpar NA, Ain Munir Abbasi SU, Zahid T, et al. Trends and Disparities in Appendicitis-Related Mortality Across U.S. Demographics and Regions: A 22-Year CDC WONDER Database Study. World J Surg. 2025;49(9):2399-408.
Petroianu AVB, Thiago Vinicius. Pathophysiology of Acute Appendicitis. JSM Gastroenterology and Hepatology. 2016;4(3):1062.
Narula N, Gibbs KE, Kong F, Mukherjee I. Appendiceal Intussusception, Diverticula, and Fecalith Associated With Appendicitis. Am Surg. 2023;89(12):6257-9.
Bordeianou L, Machado J. Management of acute appendicitis in adults. 2025 [cited 13 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 13 January 2026]. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults.
TeachMeSurgery. Acute Appendicitis London: TeachMeSeries Ltd; 2024 https://teachmesurgery.com/general/large-bowel/appendicitis/.
Diaz JJ, Napolitano L, Livingston DH, Costantini T, Inaba K, Biffl WL, et al. Evidence-based, cost-effective management of acute appendicitis: An algorithm of the Journal of Trauma and Acute Care Surgery emergency general surgery algorithms work group. J Trauma Acute Care Surg. 2025;98(3):368-73.
Lu Y-T, Chen P-C, Huang Y-H, Huang F-C. Making a Decision between Acute Appendicitis and Acute Gastroenteritis. Children. 2020;7:176.
Grover CA, Sternbach G. Charles McBurney: McBurney's point. J Emerg Med. 2012;42(5):578-81.
Martin R. Acute appendicitis in adults: Clinical manifestations and differential diagnosis. 2025 [cited 13 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 13 January 2026]. https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-and-differential-diagnosis.
Sun XX, Liu H, Qin XZ, Li MR, Yan QH, Zhang GJ. The Diagnostic Value of Carnett's Test with Chronic Abdominal Pain: A Narrative Review. Curr Pain Headache Rep. 2024;28(4):251-7.
Suleiman S. Anterior cutaneous nerve entrapment syndrome. 2025 [cited 13 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 13 January 2026]. https://www.uptodate.com/contents/anterior-cutaneous-nerve-entrapment-syndrome.
Ahn S, Lee H, Choi W, Ahn R, Hong JS, Sohn CH, et al. Clinical Importance of the Heel Drop Test and a New Clinical Score for Adult Appendicitis. PLoS One. 2016;11(10):e0164574.
Hong YR, Chung CW, Kim JW, Kwon CI, Ahn DH, Kwon SW, et al. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis. J Korean Soc Coloproctol. 2012;28(5):247-52.
Karami MY, Niakan H, Zadebagheri N, Mardani P, Shayan Z, Deilami I. Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems. Ann Coloproctol. 2017;33(6):227-31.
Andersson M, Kolodziej B, Andersson RE. Validation of the Appendicitis Inflammatory Response (AIR) Score. World J Surg. 2021;45(7):2081-91.
Diaz JJ, Ceresoli M, Herron T, Coccolini F. Current management of acute appendicitis in adults: What you need to know. Journal of Trauma and Acute Care Surgery. 2025;98(2):181-9.
Dahabreh IJ, Adam GP, Halladay CW, Steele DW, Daiello LA, Wieland LS, et al. AHRQ Comparative Effectiveness Reviews. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015.
Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.
Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris MA, Martínez Chamorro E. Update on acute appendicitis: Typical and untypical findings. Radiologia (Engl Ed). 2023;65 Suppl 1:S81-s91.
Tandoyo A, Hendwell. Comparative Diagnostic Accuracy of Computed Tomography, Magnetic Resonance Imaging, and Ultrasonography for Acute Appendicitis: A Systematic Review. The International Journal of Medical Science and Health Research. 2025;19:1-49.
Kang S, Inaba K, Foran C. Acute appendicitis in adults: Diagnostic evaluation. 2025 [cited 18 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 18 January 2026]. https://www.uptodate.com/contents/acute-appendicitis-in-adults-diagnostic-evaluation.
Joseph Forrester M, MSc, FACSPaul M Maggio, MD, MBA, FACS. Acute appendicitis in adults: Clinical manifestations and differential diagnosis. Waltham, MA: UpToDate; 2025 [cited 2025 28 December]. https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-and-differential-diagnosis.
Schuster KM, Holena DN, Salim A, Savage S, Crandall M. American Association for the Surgery of Trauma emergency general surgery guideline summaries 2018: acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstruction. Trauma Surg Acute Care Open. 2019;4(1):e000281.
Desai AH, Bagdaib AB, Parmar TPK. Postoperative Wound Infection Rates Following Open vs. Laparoscopic Appendectomy: A Comparative Study. European Journal of Cardiovascular Medicine. 2025;15(4):686-8.
Valioulis I, Farmakis C. Comparison between Open and Laparoscopic Appendectomy: A Systematic Review. World Journal of Surgery and Surgical Research. 2018;1.
Poprom N, Wilasrusmee C, Attia J, McEvoy M, Thakkinstian A, Rattanasiri S. Comparison of postoperative complications between open and laparoscopic appendectomy: An umbrella review of systematic reviews and meta-analyses. J Trauma Acute Care Surg. 2020;89(4):813-20.
Tang G, Zhang L, Xia L, Zhang J, Chen R, Zhou R. Preoperative in-hospital delay increases postoperative morbidity and mortality in patients with acute appendicitis: a meta-analysis. Int J Surg. 2025;111(1):1275-84.
Talan DA, Di Saverio S. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021;385(12):1116-23.
Smink D, Soybel D. Management of acute appendicitis in adults. 2025 [cited 18 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 18 January 2026]. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults.
Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, et al. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015;313:2340-8.
Scheijmans JCG, Haijanen J, Flum DR, Bom WJ, Davidson GH, Vons C, et al. Antibiotic treatment versus appendicectomy for acute appendicitis in adults: an individual patient data meta-analysis. Lancet Gastroenterol Hepatol. 2025;10(3):222-33.
Harnoss JC, Zelienka I, Probst P, Grummich K, Müller-Lantzsch C, Harnoss JM, et al. Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015: CRD42015016882). Ann Surg. 2017;265(5):889-900.
Talan DA, Saltzman DJ, DeUgarte DA, Moran GJ. Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review. J Trauma Acute Care Surg. 2019;86(4):722-36.
Adibe OO, Barnaby K, Dobies J, Comerford M, Drill A, Walker N, et al. Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen. Am J Surg. 2008;195(2):141-3.
Loux TJ, Falk GA, Burnweit CA, Ramos C, Knight C, Malvezzi L. Early transition to oral antibiotics for treatment of perforated appendicitis in pediatric patients: Confirmation of the safety and efficacy of a growing national trend. J Pediatr Surg. 2016;51(6):903-7.
UCSF Infectious Diseases Management Program. Adult Appendicitis Pathway San Francisco, CA: University of California San Francisco; 2025 https://idmp.ucsf.edu/content/adult-appendicitis-pathway.
Arciniegas S, Acosta-Reyes J, Espitia de la Hoz JJ, Arias-Rodriguez S, Cotes-Mendoza LJ, Florez ID. Safety and effectiveness of opioid use in adult patients presenting to emergency services with suspected acute appendicitis: a protocol for a systematic review of the literature and network meta-analysis. BMJ Open. 2025;15(8):e102525.
UNC Children's Hospital. Pediatric Medication Dosing Guidelines Chapel Hill, NC: University of North Carolina; 2021. https://www.med.unc.edu/pediatrics/cccp/wp-content/uploads/sites/1156/gravity_forms/1-188e5632d99d8f770a150fd48b72fb22/2021/02/Pediatric-Medication-Dosing-Guildelines.pdf.
Agency for Clinical Innovation. Abdominal pain: Adult ECAT protocol St Leonards, NSW: NSW Agency for Clinical Innovation; 2024. https://aci.health.nsw.gov.au/ecat/adult/abdominal-pain.
Halvey EJ, Haslam N, Mariano ER. Non-steroidal anti-inflammatory drugs in the perioperative period. BJA Educ. 2023;23(11):440-7.
Evirgen S, Ahun E. Effects of Emergency Department Analgesia on the Management Timeline and Clinical Outcomes of Acute Appendicitis. The European Research Journal. 2025(Advanced Online Publication):1-7.
Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018;98(1):25-33.
Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res. 2020;9.
Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW, et al. Recommendations for the Use of Antiemetics: Evidence-Based, Clinical Practice Guidelines. Journal of Clinical Oncology. 1999;17(9):2971-.
Doernbecher Children's Hospital. DCH ED Appendicitis Clinical Pathway Portland, OR: Oregon Health & Science University; 2022. https://www.ohsu.edu/sites/default/files/2022-01/DCH%20ED%20Appendicitis%20Clinical%20Pathway_Jan%202022.pdf.
Isazadehfar K, Entezariasl M, Shahbazzadegan B, Nourani Z, Shafaee Y. The Comparative Study of Ondansetron and Metoclopramide Effects in Reducing Nausea and Vomiting After Laparoscopic Cholecystectomy. Acta Medica Iranica. 2017;55:254-8.
Peprah K, McCormack S. CADTH Rapid Response Reports. Ondansetron in Patients Requiring Anti-Emetics: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.; 2020.
Aukerman G, Knutson D, Miser WF. Management of the acute migraine headache. Am Fam Physician. 2002;66(11):2123-30.
Singer AJ, Garra G, Thode HC, Jr. Do emergency department patients with nausea and vomiting desire, request, or receive antiemetics. Am J Emerg Med. 2017;35(5):790-1.
Nikolov NK, Reimer HT, Sun A, Bunnell BD, Merhavy ZI. Open versus Laparoscopic Appendectomy: A Literature Review. Journal of Mind and Medical Sciences. 2024;11(1):4-9.
Referanslar
Lotfollahzadeh S, Lopez RA, Deppen JG. Appendicitis. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
di Saverio S, Podda M, de Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery : WJES. 2020;15.
Bonomo RA, Tamma PD, Abrahamian FM, Bessesen M, Chow AW, Dellinger EP, 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. 2024;79(Supplement_3):S94-S103.
Kumar SS, Collings AT, Lamm R, Haskins IN, Scholz S, Nepal P, et al. SAGES guideline for the diagnosis and treatment of appendicitis. Surg Endosc. 2024;38(6):2974-94.
Téoule P, Laffolie J, Rolle U, Reissfelder C. Acute Appendicitis in Childhood and Adulthood. Dtsch Arztebl Int. 2020;117(45):764-74.
Yang Y, Guo C, Gu Z, Hua J, Zhang J, Qian S, et al. The Global Burden of Appendicitis in 204 Countries and Territories from 1990 to 2019. Clin Epidemiol. 2022;14:1487-99.
Lapsa S, Ozolins A, Strumfa I, Gardovskis J. Acute Appendicitis in the Elderly: A Literature Review on an Increasingly Frequent Surgical Problem. Geriatrics (Basel). 2021;6(3).
Nabi R, Rath S, Ahmad Chaudhry SA, Rajpar NA, Ain Munir Abbasi SU, Zahid T, et al. Trends and Disparities in Appendicitis-Related Mortality Across U.S. Demographics and Regions: A 22-Year CDC WONDER Database Study. World J Surg. 2025;49(9):2399-408.
Petroianu AVB, Thiago Vinicius. Pathophysiology of Acute Appendicitis. JSM Gastroenterology and Hepatology. 2016;4(3):1062.
Narula N, Gibbs KE, Kong F, Mukherjee I. Appendiceal Intussusception, Diverticula, and Fecalith Associated With Appendicitis. Am Surg. 2023;89(12):6257-9.
Bordeianou L, Machado J. Management of acute appendicitis in adults. 2025 [cited 13 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 13 January 2026]. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults.
TeachMeSurgery. Acute Appendicitis London: TeachMeSeries Ltd; 2024 https://teachmesurgery.com/general/large-bowel/appendicitis/.
Diaz JJ, Napolitano L, Livingston DH, Costantini T, Inaba K, Biffl WL, et al. Evidence-based, cost-effective management of acute appendicitis: An algorithm of the Journal of Trauma and Acute Care Surgery emergency general surgery algorithms work group. J Trauma Acute Care Surg. 2025;98(3):368-73.
Lu Y-T, Chen P-C, Huang Y-H, Huang F-C. Making a Decision between Acute Appendicitis and Acute Gastroenteritis. Children. 2020;7:176.
Grover CA, Sternbach G. Charles McBurney: McBurney's point. J Emerg Med. 2012;42(5):578-81.
Martin R. Acute appendicitis in adults: Clinical manifestations and differential diagnosis. 2025 [cited 13 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 13 January 2026]. https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-and-differential-diagnosis.
Sun XX, Liu H, Qin XZ, Li MR, Yan QH, Zhang GJ. The Diagnostic Value of Carnett's Test with Chronic Abdominal Pain: A Narrative Review. Curr Pain Headache Rep. 2024;28(4):251-7.
Suleiman S. Anterior cutaneous nerve entrapment syndrome. 2025 [cited 13 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 13 January 2026]. https://www.uptodate.com/contents/anterior-cutaneous-nerve-entrapment-syndrome.
Ahn S, Lee H, Choi W, Ahn R, Hong JS, Sohn CH, et al. Clinical Importance of the Heel Drop Test and a New Clinical Score for Adult Appendicitis. PLoS One. 2016;11(10):e0164574.
Hong YR, Chung CW, Kim JW, Kwon CI, Ahn DH, Kwon SW, et al. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis. J Korean Soc Coloproctol. 2012;28(5):247-52.
Karami MY, Niakan H, Zadebagheri N, Mardani P, Shayan Z, Deilami I. Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems. Ann Coloproctol. 2017;33(6):227-31.
Andersson M, Kolodziej B, Andersson RE. Validation of the Appendicitis Inflammatory Response (AIR) Score. World J Surg. 2021;45(7):2081-91.
Diaz JJ, Ceresoli M, Herron T, Coccolini F. Current management of acute appendicitis in adults: What you need to know. Journal of Trauma and Acute Care Surgery. 2025;98(2):181-9.
Dahabreh IJ, Adam GP, Halladay CW, Steele DW, Daiello LA, Wieland LS, et al. AHRQ Comparative Effectiveness Reviews. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015.
Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.
Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris MA, Martínez Chamorro E. Update on acute appendicitis: Typical and untypical findings. Radiologia (Engl Ed). 2023;65 Suppl 1:S81-s91.
Tandoyo A, Hendwell. Comparative Diagnostic Accuracy of Computed Tomography, Magnetic Resonance Imaging, and Ultrasonography for Acute Appendicitis: A Systematic Review. The International Journal of Medical Science and Health Research. 2025;19:1-49.
Kang S, Inaba K, Foran C. Acute appendicitis in adults: Diagnostic evaluation. 2025 [cited 18 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 18 January 2026]. https://www.uptodate.com/contents/acute-appendicitis-in-adults-diagnostic-evaluation.
Joseph Forrester M, MSc, FACSPaul M Maggio, MD, MBA, FACS. Acute appendicitis in adults: Clinical manifestations and differential diagnosis. Waltham, MA: UpToDate; 2025 [cited 2025 28 December]. https://www.uptodate.com/contents/acute-appendicitis-in-adults-clinical-manifestations-and-differential-diagnosis.
Schuster KM, Holena DN, Salim A, Savage S, Crandall M. American Association for the Surgery of Trauma emergency general surgery guideline summaries 2018: acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis, and small bowel obstruction. Trauma Surg Acute Care Open. 2019;4(1):e000281.
Desai AH, Bagdaib AB, Parmar TPK. Postoperative Wound Infection Rates Following Open vs. Laparoscopic Appendectomy: A Comparative Study. European Journal of Cardiovascular Medicine. 2025;15(4):686-8.
Valioulis I, Farmakis C. Comparison between Open and Laparoscopic Appendectomy: A Systematic Review. World Journal of Surgery and Surgical Research. 2018;1.
Poprom N, Wilasrusmee C, Attia J, McEvoy M, Thakkinstian A, Rattanasiri S. Comparison of postoperative complications between open and laparoscopic appendectomy: An umbrella review of systematic reviews and meta-analyses. J Trauma Acute Care Surg. 2020;89(4):813-20.
Tang G, Zhang L, Xia L, Zhang J, Chen R, Zhou R. Preoperative in-hospital delay increases postoperative morbidity and mortality in patients with acute appendicitis: a meta-analysis. Int J Surg. 2025;111(1):1275-84.
Talan DA, Di Saverio S. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021;385(12):1116-23.
Smink D, Soybel D. Management of acute appendicitis in adults. 2025 [cited 18 January 2026]. In: UpToDate [Internet]. Waltham, MA: Wolters Kluwer, [cited 18 January 2026]. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults.
Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, et al. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015;313:2340-8.
Scheijmans JCG, Haijanen J, Flum DR, Bom WJ, Davidson GH, Vons C, et al. Antibiotic treatment versus appendicectomy for acute appendicitis in adults: an individual patient data meta-analysis. Lancet Gastroenterol Hepatol. 2025;10(3):222-33.
Harnoss JC, Zelienka I, Probst P, Grummich K, Müller-Lantzsch C, Harnoss JM, et al. Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015: CRD42015016882). Ann Surg. 2017;265(5):889-900.
Talan DA, Saltzman DJ, DeUgarte DA, Moran GJ. Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review. J Trauma Acute Care Surg. 2019;86(4):722-36.
Adibe OO, Barnaby K, Dobies J, Comerford M, Drill A, Walker N, et al. Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen. Am J Surg. 2008;195(2):141-3.
Loux TJ, Falk GA, Burnweit CA, Ramos C, Knight C, Malvezzi L. Early transition to oral antibiotics for treatment of perforated appendicitis in pediatric patients: Confirmation of the safety and efficacy of a growing national trend. J Pediatr Surg. 2016;51(6):903-7.
UCSF Infectious Diseases Management Program. Adult Appendicitis Pathway San Francisco, CA: University of California San Francisco; 2025 https://idmp.ucsf.edu/content/adult-appendicitis-pathway.
Arciniegas S, Acosta-Reyes J, Espitia de la Hoz JJ, Arias-Rodriguez S, Cotes-Mendoza LJ, Florez ID. Safety and effectiveness of opioid use in adult patients presenting to emergency services with suspected acute appendicitis: a protocol for a systematic review of the literature and network meta-analysis. BMJ Open. 2025;15(8):e102525.
UNC Children's Hospital. Pediatric Medication Dosing Guidelines Chapel Hill, NC: University of North Carolina; 2021. https://www.med.unc.edu/pediatrics/cccp/wp-content/uploads/sites/1156/gravity_forms/1-188e5632d99d8f770a150fd48b72fb22/2021/02/Pediatric-Medication-Dosing-Guildelines.pdf.
Agency for Clinical Innovation. Abdominal pain: Adult ECAT protocol St Leonards, NSW: NSW Agency for Clinical Innovation; 2024. https://aci.health.nsw.gov.au/ecat/adult/abdominal-pain.
Halvey EJ, Haslam N, Mariano ER. Non-steroidal anti-inflammatory drugs in the perioperative period. BJA Educ. 2023;23(11):440-7.
Evirgen S, Ahun E. Effects of Emergency Department Analgesia on the Management Timeline and Clinical Outcomes of Acute Appendicitis. The European Research Journal. 2025(Advanced Online Publication):1-7.
Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018;98(1):25-33.
Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res. 2020;9.
Gralla RJ, Osoba D, Kris MG, Kirkbride P, Hesketh PJ, Chinnery LW, et al. Recommendations for the Use of Antiemetics: Evidence-Based, Clinical Practice Guidelines. Journal of Clinical Oncology. 1999;17(9):2971-.
Doernbecher Children's Hospital. DCH ED Appendicitis Clinical Pathway Portland, OR: Oregon Health & Science University; 2022. https://www.ohsu.edu/sites/default/files/2022-01/DCH%20ED%20Appendicitis%20Clinical%20Pathway_Jan%202022.pdf.
Isazadehfar K, Entezariasl M, Shahbazzadegan B, Nourani Z, Shafaee Y. The Comparative Study of Ondansetron and Metoclopramide Effects in Reducing Nausea and Vomiting After Laparoscopic Cholecystectomy. Acta Medica Iranica. 2017;55:254-8.
Peprah K, McCormack S. CADTH Rapid Response Reports. Ondansetron in Patients Requiring Anti-Emetics: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health Copyright © 2020 Canadian Agency for Drugs and Technologies in Health.; 2020.
Aukerman G, Knutson D, Miser WF. Management of the acute migraine headache. Am Fam Physician. 2002;66(11):2123-30.
Singer AJ, Garra G, Thode HC, Jr. Do emergency department patients with nausea and vomiting desire, request, or receive antiemetics. Am J Emerg Med. 2017;35(5):790-1.
Nikolov NK, Reimer HT, Sun A, Bunnell BD, Merhavy ZI. Open versus Laparoscopic Appendectomy: A Literature Review. Journal of Mind and Medical Sciences. 2024;11(1):4-9.
