A 21-year-old male presents with periumbilical pain that migrated to the right lower quadrant over the past 12 hours. On exam, he has tenderness at McBurney's point and positive Rovsing's sign. What is the most appropriate definitive management?

Answer and explanation

Correct answer: C. Early laparoscopic appendectomy

  1. Step 1: Migratory abdominal pain settling in the right lower quadrant with peritoneal signs (McBurney's tenderness, Rovsing's sign) is classic for acute appendicitis.
  2. Step 2: Early appendectomy (laparoscopic preferred) within 24 hours prevents perforation, abscess formation, and generalized peritonitis.
  3. Step 3: Colonoscopy is strictly contraindicated in acute appendicitis due to perforation risk.
Answer
Early laparoscopic appendectomy.
Why not the others: 'Colonoscopy to inspect the appendiceal orifice' carries a severe risk of iatrogenic bowel perforation during acute inflammation; 'Discharge home on oral analgesics with reassurance' risks appendiceal perforation, abscess, and generalized peritonitis; 'Percutaneous drainage without operative intervention' is used only for established well-demarcated abscesses in delayed presentations.

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