Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review

David A. Talan; Gregory J. Moran; David Machado-Aranda; William K. Chiang; Brett A. Faine; Ross Fleischman; David B. Hoyt; Alan E. Jones; Amber Sabbatini; Donald M. Yealy; Julianna T. Yu; Darin J. Saltzman

doi:10.1016/j.annemergmed.2025.09.035

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Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review

Journal article

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Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review

David A. Talan, Gregory J. Moran, David Machado-Aranda, William K. Chiang, Brett A. Faine, Ross Fleischman, David B. Hoyt, Alan E. Jones, Amber Sabbatini, Donald M. Yealy, …

Annals of emergency medicine, Vol.87(6), pp.735-745

06/2026

DOI: 10.1016/j.annemergmed.2025.09.035

PMID: 41348058

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Abstract

For more than 100 years, physicians and patients considered appendicitis a surgical emergency requiring hospitalization for urgent removal of the obstructed and inflamed appendix to prevent rupture and sepsis. With the advent of modern imaging, uncomplicated appendicitis is identifiable, and later evidence showed that surgical delay does not increase the risk of appendiceal perforation. Perforation appears to be a separate disease, with uncomplicated appendicitis likely related to infection, which sometimes self-resolves. Most recently, studies compared nonoperative treatment of uncomplicated appendicitis with antibiotics and observation followed by selective surgery to urgent appendectomy, including 4 multicenter trials involving more than 2,000 adults and 2,000 children. The results led the American College of Surgeons to endorse nonoperative treatment of uncomplicated appendicitis as a safe alternative treatment. Furthermore, emergency department discharge and outpatient management appears feasible in as many as 90% of nonoperative treatment of uncomplicated appendicitis-treated patients. We review methods and results of these trials and evaluate implications for emergency care.

Antibiotics

Appendectomy

Appendicitis

Nonoperative

Uncomplicated

Details

Title: Subtitle: Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review
Creators: David A. Talan - University of California, Los Angeles
Gregory J. Moran - University of California, Los Angeles
David Machado-Aranda - University of California, Los Angeles
William K. Chiang - New York University
Brett A. Faine - University of Iowa
Ross Fleischman - University of California, Los Angeles
David B. Hoyt - University of California, Irvine
Alan E. Jones - University of Mississippi
Amber Sabbatini - University of Washington School of Medicine
Donald M. Yealy - University of Pittsburgh
Julianna T. Yu - Virginia Mason Medical Center
Darin J. Saltzman - University of California, Los Angeles
Resource Type: Journal article
Publication Details: Annals of emergency medicine, Vol.87(6), pp.735-745
DOI: 10.1016/j.annemergmed.2025.09.035
PMID: 41348058
NLM abbreviation: Ann Emerg Med
ISSN: 0196-0644
eISSN: 1097-6760
Publisher: Elsevier Inc
Language: English
Electronic publication date: 12/04/2025
Date published: 06/2026
Academic Unit: Emergency Medicine; Pharmacy Practice and Science; Internal Medicine
Record Identifier: 9985090626302771

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