Non-operative Management of Uncomplicated Appendicitis: A Review of Indications, Safety, and Clinical Algorithms
Abstract
Acute uncomplicated appendicitis has traditionally been managed with appendectomy, yet accumulating evidence supports antibiotic-only treatment as a safe alternative in carefully selected patients. This narrative review synthesizes current data on the indications, safety, treatment protocols and clinical algorithms for non-operative management of uncomplicated appendicitis in adults and children. We summarise key randomised trials, systematic reviews and guidelines evaluating antibiotic regimens, imaging-based definitions of uncomplicated disease, clinical scoring systems, and predictors of treatment failure such as appendicolith, fever, raised inflammatory markers and increased appendiceal diameter. Short-term outcomes consistently demonstrate high initial success rates, low rates of severe adverse events and comparable quality of life to surgery, while long-term data highlight a clinically acceptable recurrence risk in most settings. We also discuss special populations, including paediatric and pregnant patients, and review economic analyses comparing operative and conservative strategies. Finally, we propose practical, evidence-informed algorithms to guide shared decision-making and safe implementation of non-operative care.
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