Interval Appendectomy: Modern Review

Authors

• Daniel Scott Watkins, University of LynchburgFollow

Specialty

Trauma/Emergency General Surgery

Advisor

Melissa Linskey MD

Abstract

Abstract:

Background: Perforated appendicitis with phlegmon formation represents a complex subset of acute surgical pathology that challenges traditional management paradigms. Although appendectomy remains the standard intervention, the optimal timing and surgical approach—particularly in complicated cases—continue to evolve.

Objective: To examine the clinical rationale, emerging evidence, and decision-making frameworks guiding acute versus interval appendectomy (IA) in the management of perforated appendicitis with phlegmon.

Methods: This narrative review synthesizes contemporary literature, including prospective trials, meta-analyses, and institutional protocols, to evaluate outcomes associated with immediate surgery, nonoperative management, and delayed intervention. Diagnostic considerations, operative risk, and the increasing recognition of appendiceal neoplasms are emphasized.

Results: Recent evidence suggests that initial nonoperative management followed by selective IA may reduce perioperative morbidity and allow for comprehensive histopathologic evaluation, particularly in older adults or patients with atypical imaging findings. Nonetheless, low recurrence rates and rare missed malignancies have led some investigators to question the routine use of IA. Acute appendectomy remains appropriate in hemodynamically stable patients with favorable anatomy, whereas IA provides a prudent alternative when extensive inflammation or elevated surgical risk is present.

Conclusion: The management of perforated appendicitis with phlegmon formation requires individualized, patient-centered decision-making. Clinical stability, radiologic characteristics, and patient preferences should inform the choice between acute and interval appendectomy. As healthcare systems increasingly emphasize value-based care, future research should prioritize refining risk-stratification algorithms and diagnostic protocols to optimize surgical timing and patient outcomes.

Recommended Citation

Watkins DS. Interval Appendectomy: Modern Review. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).