Acute complicated appendicitis is defined as the presence of any of the four findings; visible hole, diffuse fibrinopurulent exudate, intra-abdominal abscess, and extraluminal fecalith. Different scoring systems such as appendicitis severity index (APSI) use different clinical and radiological parameters to diagnose complicated appendicitis. Surgical treatment is preferred over conservative treatment. Though previous studies showed open method is best for complicated appendicitis, present studies have shown that laparoscopic method also has similar results as open in terms of development of surgical site infection (superficial, deep or organ space), postoperative prolonged ileus or postoperative hospital stay. Intraoperatively irrigation of the peritoneal cavity is preferred over suction only method but is not statistically significant. Drain placement is not recommended. Postoperative antibiotics should be given for 3–6 days. Tazobactam—Piperacillin is an antibiotic of choice. Postoperative complications include surgical site infection, intra-abdominal abscess, and adhesive intestinal obstruction.
Part of the book: Appendicitis - Causes and Treatments