The records of forty-three patients with clinically diagnosed appendiceal abscess were reviewed to compare operative vs nonoperative therapy. Thirteen patients were operated on shortly after admission. Eleven of these had appendectomy or drainage of an abscess; two patients had right hemicolectomy. There were no serious complications, and median hospitalization was 7.2 days. Thirty patients were initially treated nonoperatively. Twenty-six of these did well and were discharged a median of 11 days after admission. Four patients required operations for failure to respond. One patient died of a pulmonary embolism. Four patients returned with recurrent appendicitis and underwent appendectomy. Three patients were later found to have other disease processes. Good results can be obtained with either form of therapy. Patients not operated on should be examined to exclude lesions masquerading as appendiceal abscesses.