Revised guideline for acute appendicitis. Amendments to diagnostics and treatment
Recently, the revised guideline ‘Guideline for diagnostics and treatment of acute appendicitis’ was published by the Dutch Surgical Society.
A patient with limited clinical symptoms and low suspicion of appendicitis can be assessed again at a later time, during which ultrasound diagnostics can be repeated.
Following an inconclusive ultrasound scan in children who possibly have appendicitis, it is no longer recommended to perform diagnostic laparoscopy; rather, MRI diagnostics are indicated.
In young adults with possible appendicitis, in whom a diagnosis cannot be established using ultrasound, the advice is to use MRI diagnostics instead of CT imaging; this particularly applies to women of child-bearing age.
For patients with appendicitis an appendectomy remains the recommended treatment, although one can consider treating adults with suspected simple appendicitis with antibiotics alone. It is important that this decision is made in consultation with the patient.
Laparoscopic appendectomy reduces the number of wound infections and admission length, and is therefore usually preferred over open method appendectomy.
If a patient with appendicitis is 24-28 weeks pregnant, consultation with a specialist centre is indicated regarding the obstetric management and possibly referral.
Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.