Operative Versus Non-Operative Management for Appendicitis With Abscess or Phlegmon
Operative Versus Non-Operative Management for Appendicitis With Abscess or Phlegmon
The investigators aim to determine if early operative intervention is superior to
 non-operative management for adult patients with computerized tomography (CT)-proven
 complicated appendicitis with phlegmon or abscess.
Complicated appendicitis with abscess or phlegmon represents a challenging problem to
 emergency general surgeons, and the preferred treatment remains controversial. A variety of
 therapies have been recommended including early operative intervention, delayed operative
 intervention, and non-operative management. Recently, a prospective randomized controlled
 trial from a single center was conducted in Finland comparing operative and non-operative
 management of appendiceal abscess. Patients managed in the operative arm were found to have a
 shorter length of stay, fewer re-admissions, and fewer additional interventions than those
 managed in the non-operative group, but there is no high-quality randomized control trial
 conducted in the United States to support this. The investigators, therefore plan to carry
 out a multi-center, prospective, randomized controlled trial comparing operative and
 non-operative management of complicated appendicitis with abscess or phlegmon in the United
 States.
Inclusion Criteria:

 1. Complicated appendicitis with presumed perforation on (computer tomography) CT scan AND
 phlegmon or abscess greater than 2 centimeter (cm).

 Exclusion Criteria:

 1. Antibiotic therapy greater than 24 hours prior to considering for enrollment.

 2. Attempted drainage before randomization

 3. Pregnancy

 4. Antibiotic allergy requiring the use of something other than a beta-lactam or
 quinolone based therapy.

 5. Previous major intra-abdominal surgery by laparotomy

 6. Hospitalization within 2 weeks of randomization

 7. Presence of septic shock on admission.

 8. Mechanical ventilation

 9. Acute renal failure requiring dialysis