The Management of Perforated Acute Appendicitis in Adult and Pediatric Populations
The Management of Perforated Acute Appendicitis in Adult and Pediatric Populations
Patients admitted at Marshall Health - Cabell Huntington Hospital with the diagnosis of acute
 perforated appendicitis or appendicular abscess larger than 3cm will be admitted and treated
 with percutaneous drainage and the IV antibiotics for 3 days. If the patient becomes afebrile
 and has a normal WBC, the patient will stay in the hospital for a single day with oral
 antibiotics and then will be discharged to continue oral antibiotics for seven more days. If
 the patient is febrile or has elevated WBC either after the 3 days of IV antibiotics or the
 single day of oral antibiotics, the patient will complete a course of IV antibiotics for a
 total of seven days. If still febrile, the patient will undergo further assessment.

 A follow up will be conducted ~10 days after discharge from the hospital to determine if the
 patient is still symptomatic or asymptomatic. Asymptomatic patients will be followed up every
 month for 3 months, while symptomatic patients will be treated as needed. After 12 weeks,
 subjects will be randomized to interval appendectomy vs observation. Follow-ups will occur
 every 3 months for 12 months, when the study will be concluded.
Inclusion Criteria:

 -  Men and women of all ages.

 -  Clinical and radiological diagnosis by contrast CT scan of acute perforated
 appendicitis.

 -  Formal consent for the present study must be signed by the patient or his/her parents

 -  Patients with initial presentation of a phlegmon (abscess in evolution)

 Exclusion Criteria:

 -  Patients with non-perforated appendicitis

 -  Presentation with initially non-perforated appendicitis but found perforation at
 surgery

 -  Patient with septic shock

 -  Patients who had previous appendectomy

 -  Current treatment of malignancy

 -  Immunocompromised patients

 -  Positive pregnancy test

 -  No consent for the study