Emergency surgery updates in the management of appendicitis, cholecystitis, and intestinal perforations

To review and synthesize updates (last five years) in the surgical and non-surgical management of acute appendicitis, acute cholecystitis, and intestinal perforations, emphasizing indications, timing of intervention, the role of antibiotic therapy, source control, and management in septic patients. Methods: Narrative review of guidelines, randomized controlled trials, meta-analyses, and systematic reviews indexed in PubMed/PMC, SciELO, and international databases between 08/2020 and 08/2025. 

Results: (1) Appendicitis: Appendectomy remains the standard in most scenarios; however, non-operative antibiotic therapy is a selected option for uncomplicated appendicitis with well-defined criteria. Recent evidence shows higher recurrence rates but lower immediate morbidity in some RCTs. 

(2) Acute cholecystitis: A consolidated trend toward early cholecystectomy (preferably laparoscopic) in operable patients, guided by severity classification (Tokyo Guidelines), with percutaneous drainage/cholecystostomy as an option for high-risk patients. 

(3) Intestinal perforations/peritonitis: Emphasis on early source control, aggressive resuscitation, and “damage control” strategies when indicated; limited role for open abdomen, reserved for specific situations. 

Conclusion: Modern management favors individualized decisions integrating risk stratification, diagnostic imaging, guided empirical antibiotic therapy, and early source control; gaps remain regarding optimal selection for non-operative treatment in appendicitis and early criteria for “damage control” surgery.