A 5 year old boy was admitted to a rural New Zealand hospital with 10 day history of abdominal pain. The pain was localised to the RIF with guarding and examination revealed a palpable mass in the RIF. He had previously presented with a 1 day history of severe abdominal pain and fever and had been discharged the following day with a diagnosis of gastroenteritis. He was transferred to the tertiary hospital and a diagnosis was made on ultrasound scan of appendiceal mass with abscess. His condition was stable. He was commenced on conservative management and supportive care with intravenous (iv) antibiotics followed by a 2 week course of oral antibiotics. He responded well to conservative management and was scheduled for appendectomy after an interval of 6-8 weeks. You wonder whether it is necessary, now he is well, for him to have an appendectomy.

Is it reasonable to leave someone with an appendix just ready to become inflamed again? Or should the poor little thing be left alone, rather than expose the peritoneum to the risks of the open air and a surgeon’s gloves?

Mark Fisher and Maud Meates-Dennis from University of Otago, Christchurch have decided to look for an answer…

… and they found one – it’s online here