Marked peritonitis or abdominal gas may compromise the examination. Sonography is not as accurate as CT for the evaluation of phlegmon or abscess. Laparoscopy may be useful in women of childbearing age when gynecologic conditions cannot be excluded. An additional advantage to laparoscopy is that if uncomplicated appendicitis is confirmed, the appendix can often be removed laparoscopically. The treatment of appendicitis is prompt appendectomy.
Preoperative preparation consists of intravenous volume repletion and antibiotic therapy.
For simple appendicitis, one dose of a broad-spectrum antibiotic given before surgery and one dose given postoperatively are sufficient. Either ampicillin-sulbactam or a cephalosporin, such as cefotetan, is appropriate in doses previously mentioned for diverticulitis or adjusted as necessary for children. If perforated appendicitis is suspected, antibiotic coverage should be similar to that recommended for complicated diverticulitis. If phlegmon or abscess is confirmed, antibiotics are continued for 7 to 14 days postoperatively. Patients with free, uncontained perforation should be given saline abdominal lavage during surgery.