A 32-year-old man presents to the emergency department with acute onset severe right lower abdominal pain, fever (38.5°C), and localized tenderness over McBurney's point. Abdominal ultrasound shows a dilated, non-compressible appendix (8 mm diameter) with surrounding free fluid. WBC is 14,200/μL with left shift. What is the most appropriate immediate next step in management?

Explanation

## Clinical Context This patient has acute appendicitis with clear clinical and imaging evidence. The presentation is classic: McBurney's point tenderness, fever, elevated WBC with left shift, and ultrasound confirmation of appendiceal inflammation. ## Why Emergency Appendectomy Is Correct **Key Point:** Acute appendicitis is a surgical emergency. Once diagnosis is established (clinically + imaging), definitive treatment is appendectomy to prevent perforation, peritonitis, and sepsis. **High-Yield:** The gold standard management of acute appendicitis is surgical removal. Delay increases risk of perforation (which occurs in ~20% if untreated beyond 48 hours) and life-threatening complications. **Clinical Pearl:** While "appendicitis-on-a-string" (early, uncomplicated appendicitis) may rarely be managed conservatively with antibiotics in select centers, the standard teaching and NEET PG expectation is operative management once diagnosis is confirmed. ## Management Algorithm ```mermaid flowchart TD A[Acute appendicitis suspected]:::outcome --> B{Imaging confirms appendicitis?}:::decision B -->|Yes, uncomplicated| C[Resuscitate + optimize]:::action C --> D[Emergency appendectomy]:::action B -->|Yes, perforated| E[Aggressive resuscitation]:::action E --> D B -->|No| F[Reassess diagnosis]:::action D --> G[Appendicitis resolved]:::outcome ``` ## Why Other Options Are Suboptimal | Option | Problem | |--------|----------| | **Antibiotics + observe** | Delays definitive treatment; risk of perforation and peritonitis increases significantly after 48 hours. Not standard of care once diagnosis is confirmed. | | **CT abdomen** | Diagnosis is already confirmed by ultrasound + clinical findings. CT adds delay and radiation; not necessary for uncomplicated appendicitis. | | **Discharge with oral antibiotics** | Dangerous. Acute appendicitis requires hospital admission and surgery. Outpatient management risks perforation and sepsis. | **Tip:** In NEET PG, once acute appendicitis is diagnosed on imaging, the answer is almost always "proceed to surgery." Conservative management is NOT the standard answer.