Overview
Acute perforated appendicitis is a surgical emergency characterized by appendiceal rupture leading to peritonitis, necessitating prompt diagnosis and intervention to prevent severe complications such as sepsis and mortality 1.Diagnosis
Clinical Presentation: Severe abdominal pain, fever, peritoneal signs (rebound tenderness, guarding) 1.
Diagnostic Imaging: Abdominal CT scan is crucial for confirming perforation, identifying free air, abscesses, and extent of peritonitis 1.
Laboratory Tests: Elevated white blood cell count, inflammatory markers (CRP, ESR) 1.Management
Surgical Intervention: Emergency laparotomy or laparoscopy for appendectomy, drainage of abscesses if present 1.
Antibiotics: Broad-spectrum coverage (e.g., ceftriaxone and metronidazole) initiated preoperatively and tailored based on culture results 1.
Source Control: Removal of necrotic tissue, thorough lavage, and drainage of any collections to prevent recurrent sepsis 1.Special Populations
Pediatrics: Rapid recognition and transfer to pediatric surgical facilities are critical to minimize morbidity and mortality 1.Key Recommendations
Prompt surgical intervention (laparotomy or laparoscopy) for confirmed cases of acute perforated appendicitis to prevent sepsis and mortality (Evidence: Strong 1).
Initiate broad-spectrum antibiotics preoperatively and adjust based on culture results to ensure effective antimicrobial coverage (Evidence: Strong 1).
Ensure rapid transfer to specialized pediatric surgical care in children to optimize outcomes (Evidence: Strong 1).References
1 Syrett-Page J, Heaton PA, Jenner L, Paul SP. Acute abdominal surgical presentations in children. British journal of nursing (Mark Allen Publishing) 2021. link