Perforated Appendicitis With Delayed Presentation

Inclusion Criteria: * All children with a delayed diagnosis of perforated appendicitis. Delayed diagnosis will be defined as symptoms for 4 or more days. Duration of symptoms will be defined as the time pain started. * Confirmed diagnosis of perforated appendicitis. The diagnosis of perforated appendicitis will be based on diagnostic imaging (CT scan or ultrasound), showing an established appendiceal abscess or phlegmon. * Consent to participate Exclusion Criteria: * Uncertainty about the diagnosis. * The need for laparotomy for another reason. * Free intraperitoneal air on imaging. * Perforated appendicitis with diffuse abdominal fluid on imaging associated with a clinical picture of severe sepsis. * Children with other medical condition that may affect the decision to operate e.g: children with inflammatory bowel disease.