Overview
Recurrent appendicitis is characterized by recurrent episodes of abdominal pain and symptoms over months or years, often presenting similarly with each episode 1. This condition is typically encountered in adults with previously undifferentiated abdominal pain 1.Diagnosis
Prior negative computed tomography of the abdomen and pelvis (CTAP) within 12 months does not provide sufficient evidence to safely avoid or routinely recommend repeat CTAP imaging 1.
If CTAP with IV contrast is negative, ultrasound is not suggested unless pelvic or biliary pathology is suspected 1.
Screening for depression and/or anxiety may be considered during the emergency department evaluation 1.Management
An opioid-minimizing strategy for pain control is suggested 1.Key Recommendations
If a prior negative CTAP has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended 1. (Evidence: Weak)
If CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology 1. (Evidence: Moderate)
We suggest that screening for depression and/or anxiety may be performed during the ED evaluation 1. (Evidence: Expert opinion)References
1 Broder JS, Oliveira J E Silva L, Bellolio F, Freiermuth CE, Griffey RT, Hooker E et al.. Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE-2): Low-risk, recurrent abdominal pain in the emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2022. link