WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Research output: Contribution to journalArticle


  • Salomone Di Saverio
  • Arianna Birindelli
  • Micheal D Kelly
  • Fausto Catena
  • Dieter G Weber
  • Massimo Sartelli
  • Michael Sugrue
  • Mark De Moya
  • Carlos Augusto Gomes
  • Ferdinando Agresta
  • Ernest E Moore
  • Kjetil Soreide
  • Ewen Griffiths
  • Steve De Castro
  • Jeffry Kashuk
  • Yoram Kluger
  • Ari Leppaniemi
  • Luca Ansaloni
  • Manne Andersson
  • Federico Coccolini
  • Raul Coimbra
  • Kurinchi S Gurusamy
  • Fabio Cesare Campanile
  • Walter Biffl
  • Osvaldo Chiara
  • Fred Moore
  • Andrew B Peitzman
  • Gustavo P Fraga
  • David Costa
  • Ronald V Maier
  • Sandro Rizoli
  • Zsolt J Balogh
  • Cino Bendinelli
  • Roberto Cirocchi
  • Valeria Tonini
  • Alice Piccinini
  • Gregorio Tugnoli
  • Elio Jovine
  • Roberto Persiani
  • Antonio Biondi
  • Thomas Scalea
  • Philip Stahel
  • Rao Ivatury
  • George Velmahos
  • Roland Andersson

Colleges, School and Institutes

External organisations

  • Emergency and Trauma Surgery - Maggiore Hospital, AUSL, Bologna, Italy.
  • S. Orsola Malpighi University Hospital - University of Bologna, Bologna, Italy.
  • Locum Surgeon, Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia.
  • Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy.
  • Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia.
  • Macerata Hospital, Macerata, Italy.
  • Letterkenny Hospital, Donegal, Ireland.
  • Harvard Medical School - Massachusetts General Hospital, Boston, USA.
  • Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil.
  • General Surgery, Civil Hospital - ULSS19, Veneto, Adria, RO Italy.
  • Denver Health System - Denver Health Medical Center, Denver, USA.
  • Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
  • Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham
  • Department of Surgery, OLVG, Amsterdam, The Netherlands.
  • Department of Surgery, University of Jerusalem, Jerusalem, Israel.
  • Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.
  • Abdominal Center, University of Helsinki, Helsinki, Finland.
  • General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
  • Department of Surgery, Linkoping University, Linkoping, Sweden.
  • UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA USA.
  • University College London
  • Department of Surgery, San Giovanni Decollato Andosilla Hospital, Viterbo, Italy.
  • Queen's Medical Center, University of Hawaii, Honolulu, HI USA.
  • Niguarda Hospital, Milan, Italy.
  • University of Florida, Gainesville, Florida 32611, USA
  • Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA.
  • Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil.
  • Alicante, Spain.
  • Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA.
  • St. Michael Hospital, Toronto, Canada.
  • Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia.
  • Department of Surgery, Terni Hospital, University of Perugia, Terni, Italy.
  • Trauma Surgery Unit - Maggiore Hospital AUSL, Bologna, Italy.
  • Department of Surgery, Maggiore Hospital AUSL, Bologna, Italy.
  • Catholic University, A. Gemelli University Hospital, Rome, Italy.
  • Department of Surgery, University of Catania, Catania, Italy.
  • R. Adams Cowley Trauma Center, Baltimore, MD USA.
  • Professor Emeritus Virginia Commonwealth University, Richmond, VA USA.
  • Harvard Medical School - Chief of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, USA.


Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.


Original languageEnglish
Pages (from-to)34
JournalWorld Journal of Emergency Surgery
Publication statusPublished - 18 Jul 2016