David A. Talan, M.D., and Salomone Di Saverio, M.D., Ph.D.
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence
various strategies is then presented, followed by a review of formal guidelines, when they exist.
The article ends with the authors’ clinical recommendations.
A previously healthy 28-year-old woman presents to the emergency department with
a 2-day history of abdominal pain that began in the umbilical area and migrated to
the right lower abdomen. She is a single mother who works remotely and is raising a
5-year-old child. Her temperature is 37.8°C; other vital signs are normal. She rates
her pain at 7 on a scale of 1 to 10, with 10 representing the worst possible pain. Examination
reveals tenderness in the right lower quadrant, with moderate localized
rebound. The result of a pregnancy test is negative, as is the result of a polymerasechain-
reaction assay for severe acute respiratory syndrome coronavirus 2 (SARSCoV-
2). Her white-cell count is 12,500 per cubic millimeter. Computed tomography
(CT) performed after the intravenous administration of contrast material shows a
dilated, inflamed appendix without appendicolith, abscess, perforation, or tumor.
How would you manage this case?