Why do some need emergency surgery for a ruptured appendix while others only need antibiotics first?

Timing&Condition: Once appendicitis begins, the appendix will typically rupture within 2-3 days, if left untreated. If your body "band-aids" the hole closed, a smoldering infection develops best rx'd with antibiotics (+/-abscess drainage) followed by delayed appendectomy (after inflammation resolves). If the rupture is not contained (generalized peritonitis), we have no choice but to go in and remove the appendix.