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Perforated appendicitis — RCPSC EM MCQ

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HardGI/Abdominal emergenciesPerforated appendicitisRCPSC EM

A 31-year-old has CT-confirmed perforated appendicitis with localized peritonitis, fever, tachycardia and a small abscess. What is the most appropriate initial management?

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Correct answer: B — Begin IV resuscitation plus antibiotics with early surgical review

The best answer is “Begin IV resuscitation plus antibiotics with early surgical review”. Complicated appendicitis requires hospital management: stabilize the patient, provide analgesia, keep nil by mouth, give empiric IV antibiotics when perforated or septic, and involve general surgery early. The eventual operative or non-operative source-control approach depends on anatomy and local surgical expertise, but outpatient treatment, passive waiting or withholding antibiotics are unsafe in this presentation.

Reference: Emergency Care BC: Acute Appendicitis: https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-appendicitis/