The objective of medical management is to quickly identify patients who require surgical intervention (ie, for appendicitis) and to refer appropriately. Inpatient care is indicated for patients with complications. When the diagnosis is not clear, admission for observation may be necessary.
Empiric, broad-spectrum antibiotics may be used in moderately to severely ill patients and should cover Yersinia strains, commonly causative in mesenteric adenitis. General supportive care includes hydration and pain medication after excluding acute surgical abdomen. Patients with mild, uncomplicated presentations do not require antibiotics, and supportive care generally suffices.
Make early contact with a general surgeon while evaluating the patient to exclude etiologies that require urgent surgery.
Prompt transfer of patients to a facility where an appropriate workup can be conducted is the most important prehospital goal.
Vascular access and saline infusion are beneficial for patients who are more ill and have volume depletion.
Emergency department treatment
Carefully evaluate patients to exclude potentially life-threatening alternative diagnoses.
Initiate appropriate workup. Consult with a general surgeon when indicated.
Patients with volume depletion, significant electrolyte imbalance, and/or sepsis require hospital admission.
In instances for which diagnosis is not clear, inpatient observation and further workup may be appropriate.
No particular diet is recommended, although temporary withholding of oral intake may be necessary while nausea and vomiting resolve and initially until a definitive diagnosis is confirmed.
Schedule early outpatient follow-up visits to ensure complete resolution of symptoms.
No further diagnostic tests are required for patients who recover completely. This is the case for most patients.
Surgery is usually indicated in suppuration and/or abscess, with signs of peritonitis, or if acute appendicitis cannot be excluded with certainty.
At laparotomy, the diagnosis is generally clear. An appendectomy should be performed in view of the tendency for recurrence of lymphadenitis and the difficulty in differentiating adenitis from appendicitis.
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