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  • Clinical suspicion of appendicitis in an ill-appearing patient.

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Absolute

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  • None.

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Relative

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  • Presence of large periappendiceal abscess, which may be treated best with initial drainage and interval appendectomy.
  • Suspicion of Crohn's disease involving the cecum at the base of the appendix.

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Open Appendectomy

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  • The patient should be supine with both arms extended.
  • The entire abdomen is prepared and draped in case a midline incision is needed (eg, unexpected disease is encountered or the operative course dictates it).

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Laparoscopic Appendectomy

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  • The patient is supine with both arms tucked at the sides. The operating surgeon and assistant stand on the patient's left.
  • A Foley catheter is placed to decompress the bladder.
  • The patient's entire abdomen is prepared and draped.

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  • Patients should be advanced to a regular diet as tolerated and discharged home when they can tolerate oral intake and manage pain with oral medication only.

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  • Injury to bowel or other adjacent structures.
  • Intra-abdominal abscess.
  • Superficial wound infection (more common with open appendectomy).
  • Colonic fistula.

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