Question special
Resident

Thank you all for giving us this opportunity to learn about decision making in this patient population; especially now that these patients may become more frequent internal medicine admissions!

During the randomization process, a sub-group that was excluded from randomization were patients whom phlegmon (without abscess or appendicolith) was present on imaging and the surgeon deemed the patient would likely need a more extensive procedure (ileocolectomy).

I see phlegmon as being a serious grey area when a clinician is initially deciding to pursue antibiotics vs surgery. If a patient has phlegmon present on initial imaging what characteristics are likely to indicate the need for surgical intervention vs antibiotics only? Especially since patients with sepsis were already excluded in this trial, indicating to me, these patients were clinically stable with only findings of phlegmon on imaging.