A 30-year-old woman presents with right iliac fossa pain and tenderness. Alvarado score is 7. Ultrasound is non-diagnostic. CT scan shows a periappendiceal phlegmon with no free perforation. She is haemodynamically stable. Current evidence-based first-line management is:
- A Emergency laparoscopic appendicectomy immediately
- B IV antibiotics with interval appendicectomy after 6–8 weeks
- C IV antibiotics alone (non-operative management) with consideration of interval appendicectomy ✓
- D CT-guided drainage and elective appendicectomy in 3 months
Correct answer: C. IV antibiotics alone (non-operative management) with consideration of interval appendicectomy
Explanation
Appendiceal phlegmon (inflammatory mass without abscess) is best managed with IV antibiotics and non-operative management. The APPAC trial and subsequent meta-analyses confirm that non-operative management with antibiotics alone is safe for uncomplicated appendicitis and phlegmon, with approximately 70% avoiding surgery at 5 years. Interval appendicectomy after 6–8 weeks is increasingly not routinely recommended unless symptoms recur (recurrence rate ~20%). Immediate surgery risks inadvertent bowel injury in an inflamed mass.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.