The Evidence-Based Clinical Practice Guidelines on the Diagnosis and Treatment of Acute Appendicitis was then submitted to the 2003 PCS Board of Regents for final approval inFebruary 2003.
OPERATIONAL DEFINITIONSUncomplicated Appendicitis
- includes the acutely inflamed, phlegmonous, suppurative, or mildlyinflamed appendix with or without peritonitis
- includes gangrenous appendicitis, perforated appendicitis, localizedpurulent collection at operation, generalized peritonitis and periappendiceal abscess
– a patient with right lower quadrant abdominal pain who presents with anatypical history and physical examination and the surgeon cannot decide whether to discharge or tooperate on the patient
EXECUTIVE SUMMARYWhen should one suspect acute appendicitis?
Consider the diagnosis of acute appendicitis when a patient presents with right lower quadrantabdominal pain.
LEVEL III EVIDENCECATEGORY A RECOMMENDATIONWhat clinical findings are most helpful in diagnosing acute appendicitis?
Acute appendicitis should be suspected in any patient (especially male) who presents with a high intensityof perceived abdominal pain of at least 7-12 hours duration, with migration to the right lower quadrant,and followed by vomiting.Although symptoms alone have a low discriminating power, the diagnosis of acute appendicitis becomesmore certain when the physical examination findings include right lower quadrant tenderness, guarding,rebound tenderness and other signs of peritoneal irritation.
LEVEL I EVIDENCECATEGORY A RECOMMENDATION
What diagnostic tests are helpful in the diagnosis of acute appendicitis?
Although the diagnosis of acute appendicitis is primarily based on the clinical findings, the followingexaminations may be helpful:A. All Cases1.White blood cell withdifferential count
LEVEL I EVIDENCECATEGORY RECOMMENDATIONB. Equivocal Appendicitis in Adults 1.CT scan 2.Ultrasound
Whenever feasible, CT scan should be preferred over ultrasonography in clinically equivocalappendicitis in adults because of its superior accuracy.
LEVEL I EVIDENCECATEGORY A RECOMMENDATIONC. Equivocal Appendicitis in the Pediatric Age Group
1. Ultrasound(graded compression)2. CT scanAlthough CT scan and ultrasound have comparable accuracy in the diagnosis of appendicitis inthe pediatric age group, ultrasound is preferred because of its lack of radiation, cost-effectiveness andavailability compared to CT scan.
LEVEL II EVIDENCECATEGORY A RECOMMENDATION