A new consensus from Italian experts offers a standardized, physiology-driven approach to managing appendiceal abscesses, aiming to reduce variability in surgical practice.

• Early appendectomy remains the go-to for grade 1 phlegmons and small abscesses, while a short conservative trial can be considered for stable, low-risk patients.
• For abscesses >3-4 cm, image-guided drainage is recommended as a temporary measure for high-risk candidates, not definitive treatment.
• Immediate surgery is mandated for patients with clinical instability or generalized peritonitis, regardless of abscess size or type.

This framework provides specific criteria for management, potentially improving care consistency and outcomes.