For over 100 years, surgical removal of the appendix has been deemed necessary to effectively treat acute appendicitis. Appendectomy remains the cornerstone of treatment for acute appendicitis, with the exception of phlegmon or appendix mass. However, in recent years this surgical dogma has been challenged and there is a growing literature to suggest that antibiotics without surgery may be an effective treatment for acute appendicitis in adults and more recently in children. However this non-operative management of acute appendicitis remains controversial and unproven due to the lack of large prospective randomized controlled trials.