Perioperative management - Appendectomy, open

• Any clinical suspicion of appendicitis.
• An unremarkable ultrasound study and normal inflammation parameters do not rule out this diagnosis!
• In young women laparoscopic appendectomy should be performed (particularly in the context of possible gynecologic differential diagnoses).
• Laparoscopy whenever the clinical situation is marked and other differential diagnoses (e.g., sigmoid diverticulitis, gynecologic causes, etc.) cannot be ruled out.

• Acute episode of Crohn disease with so-called "concomitant appendicitis". Initial medical treatment, surgery only in case of further clinical deterioration.
  Caution: Inflammatory changes at the cecum increase residual stump rupture rate and secondary fistula formation.
• So called "concomitant appendectomy" during other abdominal procedures.

• Mandatory: Medical history, clinical examination, lab tests.
• Ultrasonography is optional (operator-dependent).
• Gynecologic consultation in women and whenever medical history demonstrates possible gynecologic causes (e.g., adnexitis) 
• CT study in "acute abdomen" if diagnosis is still uncertain after all other studies (clinical picture, lab panel, ultrasound). [NG CS et al. BMJ. 2000; 325: 1387]

None

• Secondary healing
• Intraabdominal abscess requiring revision or percutaneous drainage
• Postoperative ileus
• Adhesions
• Stump rupture
• Injury to other segments of the bowel, vessels, nerves (e.g., ilioinguinal nerve on the internal oblique)