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Recent substantial changes in surgical care apply to the most common acute pediatric surgical condition: appendicitis. This review focuses on the specific aspects of diagnosis and management of appendicitis that have shifted dramatically. We highlight three areas: the role of imaging in diagnosis; the use of antibiotics to halt progression of appendicitis, allowing for appendectomy in the morning rather than in the middle of the night; and the role for deferral of surgery in certain complex cases of appendicitis. We describe the current approach to these aspects of diagnosis and management and examine the basis for this approach.

Clinicians accepted the premise that inflammation of the vermiform appendix caused a common intra-abdominal illness only in the late 1880s, when Reginald Fitz at Harvard carefully reviewed 257 autopsy cases and coined the now universally accepted term “appendicitis.”(2) His prescient...

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