Complicated acute appendicitis: Evidence-based surgical management, postoperative complications, and strategies for improved outcomes

Complicated acute appendicitis is a severe form of appendiceal inflammation characterized by gangrene, perforation, abscess formation, or generalized peritonitis. It remains an important cause of emergency abdominal surgery and may lead to significant morbidity when diagnosis or treatment is delayed. Effective management requires rapid clinical assessment, appropriate imaging, timely surgical intervention, and rational antibiotic therapy. Although laparoscopic appendectomy is widely used, selected patients with localized appendiceal abscesses may benefit from initial non-operative management. This article reviews the pathophysiology, diagnostic approaches, evidence-based surgical strategies, postoperative complications, and methods for improving clinical outcomes.