General remarks


Acute appendicitis has 6 types:

  1. catarrhalis appendicitis; slightly red
  2. phlegmonous: moderate inflammation and ischaemia
  3. gangrenous: (partial) necrosis
  4. perforated
  5. appendicular mass
  6. appendicular abscess


In case of an acute appendicitis, an appendectomy should be performed, either by laparotomy or by laparoscopy. In uncomplicated cases antibiotics could be both effective and safe, but still 20% of people have a recurrence within a year and require eventual appendectomy. Fertile females should get a laparoscopy, to exclude any gynaecologic pathology. An appendicular mass should be treatment with medicine and other conservative measures (e.g. rest, no enteral nutrition) Abscesses should be drained.


All patients with an acute appendicitis should receive antibiotics. Normally the patient receives a single dose of antibiotics against gram-positive, gram-negative an anaerobes organisms. This treatment should be continued for 5 days in case of gangrenous and perforated appendicitis. In children a total of three days is sufficient.


ll The skin can be closed entirely, and does not cause more wound-site infections compared to an approximating stitch. This also accounts for a perforated appendicitis.

Step by step

  1. Skin incision at McBurney's point
  2. Opening Scarpa's fascia
  3. Opening aponeurosis
  4. Atraumatic spreading of muscle fibers
  5. Identify and opening of peritoneum
  6. Identify cecum and appendix
  7. Deliver cecum and appendix
  8. Identify and ligate appendiceal artery
  9. Crush appendix at base
  10. Ligate and remove appendix at base
  11. If desired place a purse string suture around base of appendix
  12. Closing peritoneum
  13. Closing aponeurosis
  14. Skin closure

  1. Let us shorten antibiotic prophylaxis and therapy in surgery. Wittmann DH, Schein M. Am J Surg. 1996 Dec;172(6A):26S-32S.
  2. Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis.Mui LM, Ng CS, Wong SK, Lam YH, Fung TM, Fok KL, Chung SS, Ng EK. ANZ J Surg. 2005 Jun;75(6):425-8
  3. Minimum postoperative antibiotic duration in advanced appendicitis in children: a review.Snelling CM, Poenaru D, Drover JW. Pediatr Surg Int. 2004 Dec;20(11-12):838-45.
  4. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Andersen BR, Kallehave FL, Andersen HK. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001439. Review
  5. Gangrenous and perforated appendicitis: a meta-analytic study of 2532 patients indicates that the incision should be closed primarily. Rucinski J, Fabian T, Panagopoulos G, Schein M, Wise L. Surgery. 2000 Feb;127(2):136-41.
  6. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. Varadhan KK, Neal KR, Lobo DN. BMJ. 2012 Apr 5;344