Episode 139: EBM Acute Appendicitis in Adults Part 2

Adult appendicitis management requires a nuanced approach to imaging and intervention. CT with IV contrast serves as the primary diagnostic modality for most adults, offering high sensitivity and specificity, while ultrasound and MRI are prioritized for pregnant patients to minimize radiation exposure. Low-dose CT protocols provide comparable diagnostic accuracy to standard-dose imaging. While surgical appendectomy remains the standard of care, non-operative management with antibiotics is a viable alternative for select patients with uncomplicated appendicitis. However, the presence of an appendicolith significantly increases the risk of treatment failure and complications, necessitating careful shared decision-making. Clinical assessment, including signs like Rovsing’s, psoas, and obturator, alongside scoring systems like AIR, adult appendicitis, and RIPASA, remains critical for risk stratification before proceeding to imaging or surgery.