MRI is being used by some centers in cases of suspected periappendiceal abscess, although once identified, US is generally used to track resolution or postsurgical complications Management Initially, therapy should be directed toward proper resuscitation with assessment and management of the airway, breathing, and circulation Extremely ill children may require endotracheal intubation in cases of shock Hypovolemia should be rapidly corrected with normal saline or Ringer’s lactate solution An initial bolus of fluid starting at 20 to 60 mL/kg is given rapidly until vital signs are improved and the patient produces urine Vasopressor therapy should be considered for patients who not have sufficient response to 60 to 80 mL/kg of isotonic fluids Broad-spectrum antibiotics targeting bowel flora (gram-negative enterics as well as anaerobes) should be given Immediate surgical consultation is necessary Placement of a bladder catheter and central venous access with measurement of central venous pressure may be necessary to monitor response to therapy Once the patient is more stable, the surgeons generally request advanced radiologic imaging to guide next steps FIGURE 116.4 CT scan of perforated appendix with abscess