Appendicitis - Management in the case of appendicular abscess

Dear Ask The Doctor: My nephew is at the hospital right now. His parents took him last night to a local er....they diagnosed him with an appendicitis and transported him to a local childrens er by ambulance where he was to receive an appendectomy. Once at the childrens unit, he was admitted and his parents told his appendix was too "bad" to remove at this time. They are going to keep him and use iv antibiotics to start and then send him home on oral antibiotics for 6 weeks and then remove the organ. I have never heard of this. His parents are flipping out and I was curious, can they ask to be transfered to a different chidrens hospital without lose of insurance coverage? Doesn't that organ need to be removed quickly?

Dear Barb: The probable reason that surgery may have been delayed could be due to the development of a localized abscess or inflammatory mass (phlegmon). The rationale for initial nonoperative treatment is to reduce the inflammation and to avoid the morbidity of immediate appendectomy in these patients while definitively treating the underlying appendicitis. An interval appendectomy is often performed 8 to 12 weeks following resolution of the initial episode of appendicitis in patients with appendiceal mass/phlegmon.