Acute Appendicitis in Adults: Diagnosis, Emergency Assessment, and Management-An Updated Review for Medical Emergency Professionals.

Background: Acute appendicitis is a cause of acute abdominal pain and remains an indication for emergency surgical assessment. Delayed diagnosis can lead to perforation and other complications, whereas overdiagnosis may lead to unnecessary imaging or surgery. Aim: This review summarizes the clinical assessment, diagnostic investigations, risk stratification, imaging approaches, and treatment options for acute appendicitis in adults. Methods: The review discusses evidence and recommendations presented in the cited literature and clinical guidelines, focusing on history and physical examination, laboratory testing, clinical scores, imaging modalities, and the choice between antibiotic treatment and appendectomy. Results: Diagnosis relies on integrating symptom patterns and examination findings with laboratory and imaging results. Migration of pain to the right lower quadrant and localized tenderness support the diagnosis, but no single clinical feature or laboratory marker is sufficient to confirm or exclude appendicitis. Risk scores, including the Appendicitis Inflammatory Response score and Adult Appendicitis Score, help classify patients and guide further assessment. Computed tomography provides high diagnostic accuracy in adults, while ultrasonography is useful as an initial radiation-free test and magnetic resonance imaging is relevant during pregnancy. Appendectomy remains a treatment. Antibiotic-only management may be considered for selected patients with uncomplicated appendicitis, especially in the absence of an appendicolith, after discussion of treatment failure and recurrence risks. Complicated disease requires individualized management, including antibiotics, drainage when appropriate, or surgery. Conclusion: Accurate assessment requires a structured, risk-based approach that combines clinical findings, laboratory tests, and appropriate imaging. Treatment should reflect disease severity, patient characteristics, and informed patient preferences.