Algorithm for Acute Appendicitis

1. Supine and upright abdominal radiographs to search for an appendicolith and to exclude bowel obstruction or perforation.
2. Ultrasound of the appendix if clinical findings are equivocal
3. Abdomen/pelvic CT scan in patients with marked obesity, tense ascites or severe pain which make the ultrasound technically difficult
4. CT or ultrasound-guided drainage of periappendiceal abscess if a large collection is seen on CT or ultrasound

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