Question

A patient presents with right iliac fossa (RIF) pain of 48 hours' duration. The ultrasound (colour-Doppler) image is shown. What is the most appropriate next step in management?

• A. Surgery (appendicectomy)
• B. CECT abdomen
• C. USG-guided drainage
• D. Conservative management with antibiotics only

Hint:

USG already shows an inflamed appendix — no extra imaging is needed; treat definitively.

Answer 1

The Correct Option is A

Step 1: Interpret the clinical picture.
Right iliac fossa pain of 48 hours' duration with a diagnostic ultrasound points to acute appendicitis. The classic USG signs are a non-compressible, blind-ending tubular structure >6 mm in diameter, target/bull's-eye appearance, peri-appendiceal fluid and increased colour-Doppler flow in the wall.

Step 2: Decide on the next step.
When ultrasound confirms uncomplicated acute appendicitis, the definitive treatment is surgery (appendicectomy), ideally laparoscopic. A confident sonographic diagnosis within 48 hours does not warrant delaying definitive treatment.

Step 3: Eliminate the other options.
• CECT is reserved for equivocal cases or where the appendix is not visualised on USG; here the USG is already diagnostic, so further imaging is unnecessary.
• USG-guided drainage is appropriate only for a well-formed appendicular abscess (a later complication), not for acute appendicitis without a drainable collection.
• Antibiotics alone is not the standard definitive answer in an exam setting once appendicitis is confirmed and the patient is fit for surgery.

Step 4: Conclusion.
USG-confirmed acute appendicitis presenting acutely → proceed to surgery. Key fact: an inflamed, non-compressible blind-ending tubule >6 mm with hyperaemic wall on Doppler is diagnostic of acute appendicitis and mandates appendicectomy.