From this study, it can be concluded that patients who meet the following criteria are more likely to fail expectant management and thus should not be considered for the NOM of uncomplicated acute appendicitis. These include the duration of symptoms before presenting to a surgical emergency , the presence of fever within 24 hours of presenting to a surgical emergency, TLC cells/dL, CRP mg/L, appendix diameter mm, modified Alvarado score , and adult appendicitis score .

Expectant management with intravenous antibiotic therapy alone has emerged as an effective alternative to appendectomy for the treatment of uncomplicated acute appendicitis . It is important to identify patients at the onset of the disease who are likely to have successful outcomes for conservative management.

Inclusion Criteria:

• Male or female patients é diagnosis of acute appendicitis .
• Patients with ages: from 16 to 60 years old.

Exclusion Criteria:

• complicated AA (appendicolith, perforation, peri appendicular abscess or suspicion of a tumor).
• inflammatory bowel disease.
• inability to co-operate and give informed consent.
• diffuse peritonitis.
• antibiotic documented allergy & allergy to contrast media .
• Patients with serious comorbid conditions DM & renal insufficiency, serum creatinine > 150 μmol/l .
• Pregnant & lactating patient.
• Patients with bleeding diathesis and those on anticoagulants.
• Patients with advanced malignancies & patient on immunosuppressive drugs .
• Patients with previous appendectomy.
• Extreme of age.

Male or female patients é diagnosis of acute appendicitis Patients with ages: from 16 to 60 years old