Diagnosis and Treatment of Acute Appendicitis

Acute appendicitis is the most common abdominal surgical emergency worldwide and a leading cause of emergency hospital admissions and operations. Despite its frequency, substantial variability persists in diagnosis and management across patient populations and health care settings.

To provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis in adults, children, pregnant women, older patients (aged ≥65 years), immunocompromised individuals, and patients with obesity (body mass index ≥30), developed by the World Society of Emergency Surgery (WSES) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Evidence Review: A systematic literature search was performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library to identify relevant studies published until May 2025. Eligible designs included randomized clinical trials, observational studies, systematic reviews, and meta-analyses. Risk of bias was assessed with design-appropriate tools (RoB-2, ROBINS-I, QUADAS-2). Evidence profiles and evidence-to-decision frameworks were generated for each of 19 key clinical questions. The certainty of evidence was rated as high, moderate, low, or very low. Recommendations were classified as strong or conditional (weak) according to GRADE.