The appendix is a wormlike extension of the cecum and, for this reason, has been

called the vermiform appendix. The average length of the appendix is 8-10 cm
(ranging from 2-20 cm). The appendix appears during the fifth month of gestation,
and several lymphoid follicles are scattered in its mucosa. Such follicles increase in
number when individuals are aged 8-20 years.

Appendicitis is inflammation of the inner lining of the vermiform appendix that

spreads to its other parts. Appendicitis may occur for several reasons, such as an
infection of the appendix, but the most important step is the obstruction of the
appendiceal lumen.

Appendicitis is one of the more common surgical emergencies, and it is one of the
most common causes of abdominal pain. In the last few years, though, the incidence
and mortality rate of appendicitis has markedly decreased.

For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and
Intestine Center. Also, see eMedicine's patient education articles Appendicitis and
Abdominal Pain in Adults.

History of the Procedure

The first report of an appendectomy came from Amyan, a surgeon of the English
army. Amyan performed an appendectomy in 1735 without anesthesia to remove a
perforated appendix. Reginald H. Fitz, an anatomopathologist at Harvard who
advocated early surgical intervention, first described appendicitis in 1886. Because he
was not a surgeon, his advice was ignored for a time.

Then, at the end of the 19th century, the English surgeon H. Hancock successfully
performed the first appendectomy in a patient with acute appendicitis. Some years
after this, the American C. McBurney published a series of reports that constituted the
basis of the subsequent diagnostic and therapeutic management of acute appendicitis.

Appendectomy, either open or laparoscopic, currently remains the treatment of

noncomplicated appendicitis.

Problem

Despite diagnostic and therapeutic advancement in medicine, appendicitis remains a

clinical emergency. In fact, appendicitis is one of the more common causes of acute
abdominal pain. Left untreated, appendicitis has the potential for severe
complications, including perforation or sepsis, and may even cause death.

The diagnosis of appendicitis is clinical and essentially is based on history and

clinical examination findings. The classic form of appendicitis may be promptly
diagnosed and treated. When appendicitis appears with atypical presentations, it
remains a clinical challenge. In such cases, laboratory and imaging investigation may
be useful in establishing a correct diagnosis of appendicitis.

Statistics report that 1 of 5 cases of appendicitis is misdiagnosed; however, a normal

appendix is found in 15-40% of patients who have an emergency appendectomy.
Although many antibiotics to control infections are available, appendicitis remains a
surgical disease. In fact, appendectomy is the only rational therapy for acute
appendicitis. It avoids clinical deterioration and may avoid chronic or recurrent
appendicitis.

Although difficult, prompt recognition and immediate treatment of appendicitis

prevent complications.

Frequency

The incidence of acute appendicitis is around 7% of the population in the United

States and in European countries. In Asian and African countries, the incidence of
acute appendicitis is probably lower because of the dietary habits of the inhabitants of
these geographic areas.

In the last few years, a decrease in frequency of appendicitis in Western countries has
been reported, which may be related to changes in dietary fiber intake. In fact, the
higher incidence of appendicitis is believed to be related to poor fiber intake in such
countries.

Persons of any age may be affected, with highest incidence occurring during the
second and third decades of life. Rare cases of neonatal and prenatal appendicitis have
been reported.

Appendicitis occurs more frequently in males than in females, with a male-to-female

ratio of 1.7:1.

Etiology

Appendicitis is caused by obstruction of the appendiceal lumen. The causes of the

obstruction include lymphoid hyperplasia secondary to irritable bowel disease (IBD)
or infections (more common during childhood and in young adults), fecal stasis and
fecaliths (more common in elderly patients), parasites (especially in Eastern
countries), or, more rarely, foreign bodies and neoplasms.

Lymphoid hyperplasia of the appendix may be related to Crohn disease,

mononucleosis, amebiasis, measles, and GI and respiratory infections. Fecaliths are
solid bodies within the appendix that form after precipitation of calcium salts and
undigested fiber in a matrix of dehydrated fecal material.

Pathophysiology

Reportedly, appendicitis is caused by obstruction of the appendiceal lumen from a

variety of causes. Independent of the etiology, obstruction is believed to cause an
increase in pressure within the lumen. Such an increase is related to continuous
secretion of fluids and mucus from the mucosa and the stagnation of this material. At
the same time, intestinal bacteria within the appendix multiply, leading to the
recruitment of white cells and the formation of pus and subsequent higher
intraluminal pressure.
If appendiceal obstruction persists, intraluminal pressure rises ultimately above that of
the appendiceal veins, leading to venous outflow obstruction. As a consequence,
appendiceal wall ischemia begins, resulting in a loss of epithelial integrity and
allowing bacterial invasion of the appendiceal wall.

Various specific bacteria, viruses, fungi, and parasites can be responsible agents of
infection that affect the appendix, including Yersinia species, adenovirus,
cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species,
Schistosoma species, pinworms, and Strongyloides stercoralis.

Within a few hours, this localized condition may worsen because of thrombosis of the
appendicular artery and veins, leading to perforation and gangrene of the appendix. As
this process continues, a periappendicular abscess or peritonitis may occur.

Clinical

The most common symptom of appendicitis is abdominal pain. Typically, symptoms

begin as periumbilical or epigastric pain migrating to the right lower quadrant (RLQ)
of the abdomen. Later, a worsening progressive pain along with vomiting, nausea, and
anorexia are described by the patient. Usually, a fever is not present at this stage.

In addition to recording the history of the abdominal pain, obtain a complete summary
of the recent personal history surrounding gastroenterologic, genitourinary, and
pneumologic conditions. Also, consider gynecologic history in female patients.

The differential diagnosis of appendicitis is often a clinical challenge because

appendicitis can mimic several abdominal conditions. The differential diagnosis of
appendicitis must include cholecystitis and biliary colic, gastroenteritis, enterocolitis,
diverticulitis, pancreatitis, perforated duodenal ulcer, renal colic, and urinary tract
infection (UTI). In pediatric patients, consider mesenteric lymphadenitis and
intussusception. In women of childbearing age who are not pregnant, the differential
diagnosis of appendicitis must also include ovarian cyst torsion, mittelschmerz,
ectopic pregnancy, and pelvic inflammatory disease. Small bowel obstruction, Crohn
disease, Meckel diverticulitis, tumors, Henoch-Schnlein purpura, and rectus sheath
hematoma are more rare conditions that mimic appendicitis.

Usually, patients are lying down, flexing their hips, and drawing their knees up to
reduce movements and to avoid worsening the pain.

A careful physical examination, not limited to the abdomen, must be performed in any
patient with suspected appendicitis. GI, genitourinary, and pulmonary systems must
be studied. Perform a rectal examination in any patient with an unclear clinical
picture, and perform a pelvic examination in all women with abdominal pain.

Tenderness on palpation in the RLQ over the McBurney point is the most important
sign in these patients. Additional signs, such as increasing pain with cough (ie,
Dunphy sign), rebound tenderness related to peritoneal irritation elicited by deep
palpation with quick release (ie, Blumberg sign), and guarding, may or may not be
present.
Patients with appendicitis may not have the reported classic clinical picture 37-45% of
the time, especially when the appendix is located in an unusual place (see Relevant
Anatomy). In such cases, imaging studies may be important but not always available.
Patients with appendicitis usually have accessory signs that may be helpful for
diagnosis. For example, the obturator sign is present when the internal rotation of the
thigh elicits pain (ie, pelvic appendicitis), and the psoas sign is present when the
extension of the right thigh elicits pain (ie, retroperitoneal or retrocecal appendicitis).

In regard to variations in clinical presentation, Niwa et al reported an interesting

case of recurrent pain in a young woman referred for appendicitis and treated with
antibiotics.1 After 12 months, the woman underwent a
laparotomy, demonstrating appendiceal diverticulitis associated with a rare
pelvic pseudocyst, probably due to diverticular perforation of the pseudocyst.1

See related CME at Evaluation of Acute Abdominal Pain Reviewed.

INDICATIONS
Section 3 of 12
Authors and Editors
Introduction
Indications
Relevant Anatomy
Contraindications
Workup
Treatment
Complications
Outcome and Prognosis
Future and Controversies
Acknowledgments
References

Consider an appendectomy for patients with a history of persistent abdominal pain,

fever, and clinical signs of localized or diffuse peritonitis, especially if leukocytosis is
present.

If the clinical picture is unclear, a short period (4-6 h) of watchful waiting and a CT
scan may improve diagnostic accuracy and help to hasten diagnosis. However, if a
patient is discharged from the medical center without a definite diagnosis at the end of
the observation period, instruct the patient to return for continued or recurrent
symptoms, and the patient may benefit from a follow-up examination in 24 hours.
RELEVANT ANATOMY
Section 4 of 12
Authors and Editors
Introduction
Indications
Relevant Anatomy
Contraindications
Workup
Treatment
Complications
Outcome and Prognosis
Future and Controversies
Acknowledgments
References

The appendix is a wormlike extension of the cecum, and the average length of the
appendix is 8-10 cm (ranging from 2-20 cm). The appendix appears during the fifth
month of gestation, and its wall has an inner mucosal layer, 2 muscular layers, and a
serosa. Several lymphoid follicles are scattered in its mucosa. The number of follicles
increases when individuals are aged 8-20 years.

The inner muscular layer is circular, and the outer layer is longitudinal and derives
from the taenia coli. Taenia coli converge on the posteromedial area of the cecum.
This site is the appendiceal base. The appendix runs into a serosal sheet of the
peritoneum called the mesoappendix. Within the mesoappendix courses the
appendicular artery, which is derived from the ileocolic artery. Sometimes, an
accessory appendicular artery (deriving from the posterior cecal artery) may be found.

The vasculature of the appendix must be addressed to avoid intraoperative

hemorrhages. The course of the appendix and the position of its tip may vary widely,
accounting for the nonspecific signs and symptoms of appendicitis. In fact, many
individuals may have an appendix located in the retroperitoneal space; in the pelvis;
or behind the terminal ileum, cecum, ascending colon, or liver.

CONTRAINDICATIONS
Section 5 of 12
Authors and Editors
Introduction
Indications
Relevant Anatomy
Contraindications
Workup
 Treatment
Complications
Outcome and Prognosis
Future and Controversies
Acknowledgments
References

Patients with appendicitis always need urgent referral and prompt treatment. No
contraindications to appendectomy are known for patients with suspected
appendicitis, except in the case of a patient with a long history of symptoms and signs
of a large phlegmon. If a periappendiceal abscess or phlegmon exists secondary to
appendiceal perforation or rupture, some clinicians may choose a conservative
approach with broad-spectrum antibiotics and percutaneous drainage followed by
appendectomy later.

Certain contraindications exist for laparoscopic appendectomy. These

contraindications are extensive adhesions, radiation or immunosuppressive therapy,
severe portal hypertension, and coagulopathies. Laparoscopic appendectomy is
contraindicated in the first trimester of pregnancy.

Rarely, an appendiceal mucocele may occur. It is a collection of mucus within the

appendiceal lumen. Occasionally, patients may present with a low-grade carcinoma of
the appendix or the cecum. In such cases, the surgeon must avoid perforation during
dissection because it may cause seeding of the peritoneum with viable cells, leading to
pseudomyxoma peritonei.

WORKUP
Section 6 of 12
Authors and Editors
Introduction
Indications
Relevant Anatomy
Contraindications
Workup
Treatment
Complications
Outcome and Prognosis
Future and Controversies
Acknowledgments
References
Lab Studies

Laboratory tests are not specific for appendicitis but may be helpful to confirm
diagnosis in patients with an atypical presentation.
CBC count

o A mild elevation of WBCs (ie, >12,000/L) is a common finding in
patients with acute appendicitis. In these patients, leukocytosis occurs.
Otherwise, the WBC count has low specificity for appendicitis, and a
number of bacterial and viral diseases may also lead to leukocytosis.
o In infants and elderly patients, a WBC count is especially unreliable
because these patients may not mount a normal response to infection.
o In pregnant women, the physiologic leukocytosis renders the CBC
count useless for the diagnosis of appendicitis.
Urinalysis

o Urinalysis may be useful in differentiating appendicitis from urinary
tract conditions.
o Mild pyuria may occur in patients with appendicitis because of the
relationship of the appendix with the right ureter. Severe pyuria is a
more common finding in UTI.
o Proteinuria and hematuria suggest genitourinary diseases or
hemocoagulative disorders.
C-reactive protein

o C-reactive protein (CRP) has been reported to be useful in the
diagnosis of appendicitis. This protein is physiologically produced by
the liver when bacterial infections occur and rapidly increases within
the first 12 hours.
o CRP lacks specificity and cannot be used to distinguish between sites
of infection.
o CRP levels of greater than 1 mg/dL are commonly reported in patients
with appendicitis. Very high levels of CRP in patients with appendicitis
indicate gangrenous evolution of the disease, especially if it is
associated with leukocytosis and neutrophilia. However, CRP
normalization occurs 12 hours after onset of symptoms.
Liver and pancreatic function tests (eg, transaminases, bilirubin, alkaline
phosphatase, serum lipase, amylase) may be helpful to determine the diagnosis
in patients with an unclear presentation.
For women of childbearing age, the level of urinary betahuman chorionic
gonadotropic (beta-hCG) is useful in differentiating appendicitis from early
ectopic pregnancy.
Urinary 5-hydroxyindoleacetic acid

o According to a report, measurement of the urinary 5-
hydroxyindoleacetic acid (U-5-HIAA) levels could be an early marker
of appendicitis.2 The rationale of such measurement is related to the
large amount of serotonin-secreting cells in the appendix.
o In the cited report, U-5-HIAA levels increase significantly in acute
appendicitis, decreasing when the inflammation shifts to necrosis of
 the appendix.2 Therefore, such decrease could be an early warning sign
of perforation of the appendix.

Imaging Studies

Abdomen plain film: Occasionally, a plain film of the abdomen may

demonstrate fecalith within the appendix, but this study is rarely indicated.
Barium enema

o Although barium enema is performed only rarely, in the past this
examination was used to diagnose appendicitis.
o When barium enema is performed, the typical radiologic sign of
appendicitis is the "reverse 3." This sign typically manifests as an
indentation of the cecum. In addition, the appendix does not fill with
barium.
o The appendix cannot be visualized in 50% of healthy individuals;
therefore, barium enema lacks reliability.
Ultrasound

o A healthy appendix usually cannot be viewed with ultrasound. When
appendicitis occurs, the ultrasound typically demonstrates a
noncompressible tubular structure of 7-9 mm in diameter.
o Vaginal ultrasound alone or in combination with transabdominal scan
may be useful to determine the diagnosis in women of childbearing
age.
o False-positive results may occur in patients with Crohn disease. False-
negative results are frequent in patients with retrocecal appendix.
o The main limitation of an ultrasound is that its reliability is completely
user-dependent.
CT scan

o CT scan with oral contrast medium or rectal Gastrografin enema may
help in diagnosis of appendicitis. Intravenous contrast is not usually
necessary. It may help differentiate between appendicitis and other
pelvic pathologies.
o The typical findings are a nonfilling appendix with distention and
thickened walls of both the appendix and the cecum, enlarged
mesenteric nodes, and periappendiceal inflammation or fluid.
o Because of its cost, CT scans are generally reserved for patients with
uncertain diagnosis or severe obesity.
o Helical CT scan has demonstrated high sensitivity and specificity in
differentiating appendicitis from other conditions, and it may be cost
efficient with regards to limiting the number of unnecessary
operations.
Another diagnostic tool for acute appendicitis is radionuclide scanning using
WBCs labeled with technetium Tc-99 (99Tc). Despite its reported high
specificity and sensitivity, the procedure is time consuming and not useful in
emergency situations. It is cost effective; however, it is not widely available.
Diagnostic Procedures

Diagnostic laparoscopy may be useful in selected cases (eg, infants, elderly

patients, female patients) to confirm the diagnosis of appendicitis. If findings
are positive, such procedures should be followed by definitive surgical
treatment at the time of laparoscopy.

Histologic Findings

In the early stages of appendicitis, the appendix grossly appears edematous with
dilation of the serosal vessels. Microscopy demonstrates neutrophil infiltrate of the
mucosal and muscularis layers extending into the lumen. As time passes, the
appendiceal wall grossly appears thickened, the lumen appears dilated, and a serosal
exudate (fibrinous or fibrinopurulent) may be observed as granular roughening. At
this stage, mucosal necrosis may be observed microscopically.

At the later stages of appendicitis, the appendix grossly shows marked signs of
mucosal necrosis extending into the external layers of the appendiceal wall that can
become gangrenous. Sometimes, the appendix may be found in a collection of pus. At
this stage of appendicitis, microscopy may demonstrate multiple microabscesses of
the appendiceal wall and severe necrosis of all layers.

See related CME at The Value of Routine Histopathological Examination of

Appendicectomy Specimens.

Staging

Appendicitis usually has 3 stages.

Edematous stage

o Appendicitis may have spontaneous regression or may evolve to the
second stage.
o The mesoappendix is commonly involved with inflammation.
Purulent (phlegmonous) stage

o Spontaneous regression rarely occurs.
o Appendicitis usually evolves beyond perforation and rupture.
o Peritonitis may be possible.
Gangrenous stage

o Spontaneous regression never occurs.
o Peritonitis is present.

TREATMENT
Section 7 of 12
 Authors and Editors
Introduction
Indications
Relevant Anatomy
Contraindications
Workup
Treatment
Complications
Outcome and Prognosis
Future and Controversies
Acknowledgments
References

Medical therapy

Appendectomy remains the only curative treatment of appendicitis.

Although many controversies exist over the nonoperative management of acute

appendicitis, antibiotics have an important role in the treatment of patients with this
condition. Antibiotics considered for patients with appendicitis must offer full aerobic
and anaerobic coverage. Duration of the administration is closely related to the stage
of appendicitis at the time of the diagnosis, considering either intraoperative findings
or postoperative evolution. According to several studies, antibiotic prophylaxis should
be administered before every appendectomy. When the patient becomes afebrile and
the WBC count normalizes, antibiotic treatment may be stopped. Cefotetan and
cefoxitin seem to be the best choices of antibiotics.

Surgical therapy

Thousands of classic appendectomies (open procedure) have been performed in the

last 2 centuries. Mortality and morbidity have gradually decreased, especially in the
last few decades because of antibiotics, early diagnosis, and improvements in
anesthesiologic and surgical techniques.

Since 1987, many surgeons have begun to treat appendicitis laparoscopically. This
procedure has now been improved and standardized.

The reported results of both laparoscopic and open-procedure appendectomies seem

to be overlapping. In fact, the average rate of abdominal abscesses, negative
appendectomies, and hospital stays are very similar according to a recent overview of
17 retrospective studies.

Laparoscopy has some advantages, including decreased postoperative pain, better

aesthetic result, a shorter time to return to usual activities, and lower incidence of
wound infections or dehiscence. This procedure is cost effective but may require more
operative time compared with open appendectomy.
Preoperative details

Preparation of patients undergoing appendectomy is similar for both open and

laparoscopic procedures.

Because they may mask the underlying disease, do not administer analgesics and
antipyretics to patients with suspected appendicitis who have not been evaluated by
the surgeon.

Perform complete routine laboratory and radiologic studies before intervention.

Venous access must be obtained in all patients diagnosed with appendicitis. Venous
access allows administration of isotonic fluids and broad-spectrum intravenous
antibiotics prior to the operation.

Prior to the start of the surgical procedure, the anesthesiologist performs endotracheal
intubation to administer volatile anesthetics and to assist respiration.

The abdomen is washed, antiseptically prepared, and then draped.

Intraoperative details

Open appendectomy

Prior to incision, the surgeon should carefully perform a physical examination of the
abdomen to detect any mass and to determine the site of the incision.

Open appendectomy requires a transverse incision in the RLQ over the McBurney
point (ie, two thirds of the way between the umbilicus and the anterior superior iliac
spine). The vertical incisions (ie, the Battle pararectal) are rarely performed because
of the tendency for dehiscence and herniation.

The abdominal wall fascia (ie, Scarpa fascia) and the underlying muscular layers are
sharply dissected or split in the direction of their fibers to gain access to the
peritoneum. If necessary (eg, because of concomitant pelvic pathologies), the incision
may be extended medially, dissecting some fibers of the oblique muscle and retracting
the lateral part of the rectus abdominis. The peritoneum is opened transversely and
entered. Note the character of any peritoneal fluid to help confirm the diagnosis and
then suction it from the field; if purulent, collect and culture the fluid.

Retractors are gently placed into the peritoneum. The cecum is identified and medially
retracted. It is then exteriorized by a moist gauze sponge or Babcock clamp, and the
taenia coli are followed to their convergence. The convergence of teniae coli is
detected at the base of the appendix, beneath the Bauhin valve (ie, the ileocecal
valve), and the appendix is then viewed. If the appendix is hidden, it can be detected
medially by retracting the cecum and laterally by extending the peritoneal incision.

After exteriorization of the appendix, the mesoappendix is held between clamps,

divided, and ligated. The appendix is clamped proximally about 5 mm above the
cecum to avoid contamination of the peritoneal cavity and is cut above the clamp by a
scalpel. Fecaliths within the lumen of the appendix may be detected. The appendix
must be ligated to prevent bleeding and leakage from the lumen. The residual mucosa
of the appendix is gently cauterized to avoid future mucocele. The appendix may be
inverted into the cecum with the use of a pursestring suture or z-stitch. Although
performed by several surgeons, the appendiceal stump inversion is not mandatory.

The cecum is placed back into the abdomen. The abdomen is irrigated. When
evidence of free perforation exists, peritoneal lavage with several liters of warm saline
is recommended. After the lavage, the irrigation fluid must be completely aspirated to
avoid the possibility of spreading infection to other areas of the peritoneal cavity. The
use of a drain is not commonly required in patients with acute appendicitis, but
obvious abscess with gross contamination requires drainage.

The wound closure begins by closing the peritoneum with a running suture. Then, the
fibers of the muscular and fascial layers are reapproximated and closed with a
continuous or interrupted absorbable suture. Lastly, the skin is closed with
subcutaneous sutures or staples. In cases of perforated appendicitis, some surgeons
leave the wound open, allowing for secondary closure or a delayed primary closure
until the fourth or fifth day after operation. Other surgeons prefer immediate closure
in these cases.

Laparoscopic appendectomy

The surgeon typically stands on the left of the patient, and the assistant stands on the
right. The anesthesiologist and the anesthesia equipment are placed at the patient's
head, and the video monitor and the instrument table are placed at the feet.

Although some variations are possible, 3 cannulae are placed during the procedure.
Two of them have a fixed position (ie, umbilical, suprapubic). The third is placed in
the right periumbilical region, and its position may vary greatly depending on the
patient's anatomy.

According to the preferences of the surgeon, a short umbilical incision is made to

allow the placement of a Hasson cannula or Veress needle that is secured with 2
absorbable sutures.

Pneumoperitoneum (10-14 mm Hg) is established and maintained by insufflating

carbon dioxide. Through the access, a laparoscope is inserted to view the entire
abdomen cavity.

A 12-mm trocar is inserted above the pubic symphysis to allow the introduction of
instruments (eg, incisors, forceps, stapler). Another 5-mm trocar is placed in the right
periumbilical region, usually between the right costal margin and the umbilicus, to
allow the insertion of an atraumatic grasper to expose the appendix. The appendix is
grasped and retracted upward to expose the mesoappendix. The mesoappendix is
divided using a dissector inserted through the suprapubic trocar. Then, a linear
Endostapler, Endoclip, or suture ligature is passed through the suprapubic cannula to
ligate the mesoappendix. The mesoappendix is transected using a scissor or
electrocautery. To avoid perforation of the appendix and iatrogenic peritonitis, the tip
of the appendix should not be grasped.
The appendix may now be transected with a linear Endostapler, or, alternately, the
base of the appendix may be suture ligated in a similar manner to that in an open
procedure. The appendix is now free and may be removed through the umbilical or
the suprapubic cannula using a laparoscopic pouch to prevent wound contamination.
Peritoneal irrigation is performed with antibiotic or saline solution. Completely
aspirate the irrigant. The cannulae are then removed and the pneumoperitoneum is
reduced.

The fascial layers at the cannula sites are closed with absorbable suture, while the
cutaneous incisions are closed with interrupted subcuticular sutures or sterile adhesive
strips.

Postoperative details

Administer intravenous antibiotics postoperatively. The length of administration is

based on the operative findings and the recovery of the patient. In complicated
appendicitis, antibiotics may be required for many days or weeks.

Antiemetics and analgesics are administered to patients experiencing nausea and

wound pain.

The patient is encouraged to ambulate early. When appendicitis is not complicated,

the diet may be advanced quickly postoperatively and the patient is discharged from
the hospital once a diet is tolerated. In patients with complicated appendicitis, a clear
liquid diet may be started when bowel function returns. These patients may be
discharged after complete restitution of infection.

Follow-up

After hospital discharge, patients must have a light diet and limit their physical
activity for a period of 2-6 weeks based on the surgical approach (ie, laparoscopic,
open appendectomy). The patient should be evaluated by the surgeon in the clinic to
determine improvement and to detect any possible complications.