Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Salomone Di Saverio, Mauro Podda, Belinda De Simone, Marco Ceresoli, Goran Augustin, Alice Gori, Marja Boermeester, Massimo Sartelli, Federico Coccolini, Antonio Tarasconi, Nicola De' Angelis, Dieter G. Weber, Matti Tolonen, Arianna Birindelli, Walter Biffl, Ernest E. Moore, Michael Kelly, Kjetil Soreide, Jeffry Kashuk, Richard Ten BroekCarlos Augusto Gomes, Michael Sugrue, Richard Justin Davies, Dimitrios Damaskos, Ari Leppäniemi, Andrew Kirkpatrick, Andrew B. Peitzman, Gustavo P. Fraga, Ronald V. Maier, Raul Coimbra, Massimo Chiarugi, Gabriele Sganga, Adolfo Pisanu, Gian Luigi De' Angelis, Edward Tan, Harry Van Goor, Francesco Pata, Isidoro Di Carlo, Osvaldo Chiara, Andrey Litvin, Fabio C. Campanile, Boris Sakakushev, Gia Tomadze, Zaza Demetrashvili, Rifat Latifi, Fakri Abu-Zidan, Oreste Romeo, Helmut Segovia-Lohse, Gianluca Baiocchi, David Costa, Sandro Rizoli, Zsolt J. Balogh, Cino Bendinelli, Thomas Scalea, Rao Ivatury, George Velmahos, Roland Andersson, Yoram Kluger, Luca Ansaloni, Fausto Catena

Research output: Contribution to journalReview articlepeer-review

496 Citations (Scopus)


Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: Use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods: This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions: The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6),management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

Original languageEnglish
Article number27
JournalWorld Journal of Emergency Surgery
Issue number1
Publication statusPublished - Apr 15 2020


  • Acute appendicitis
  • Adult Appendicitis Score
  • Alvarado score
  • Antibiotics
  • Appendectomy
  • Appendiceal abscess
  • Appendicitis diagnosis score
  • Appendicitis guidelines
  • CT scan appendicitis
  • Complicated appendicitis
  • Consensus conference
  • Diagnostic laparoscopy
  • Imaging
  • Jerusalem guidelines
  • Laparoscopic appendectomy
  • Non-operative management
  • Phlegmon

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine


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