Background Acute appendicitis remains a common surgical pathology, with the accepted standard of care being an appendicectomy. However, in acute appendicitis complicated by an inflammatory phlegmon, dilemma remains regarding the best management options in this instance. The aim of our study was to look at the outcomes for patients with an appendiceal phlegmon, comparing emerging appendicectomy with those who had initial conservative management with subsequent interval appendicectomy. Methods We performed a retrospective analysis of all patients who were diagnosed with acute appendicitis with inflammatory phlegmon (January 2012 to December 2022) looking into the outcomes of patients who were managed with an emergency appendicectomy versus conservative management and subsequent interval appendicectomy. Results 127 patients were included in our study (85 emergency appendicectomy, 42 interval appendicectomy). Patients who underwent an emergency appendicectomy had a significantly shorter duration of symptoms as compared to those undergoing an interval appendicectomy (two vs seven days). Furthermore, there was a higher likelihood of either a partial caecectomy or ileocolic/right hemicolectomy in those undergoing an emergency appendicectomy (p=0.021). However, there was no difference in 30-day morbidity or mortality. Conclusion This study highlights the challenge in the management of appendiceal phlegmons. We propose that early emergency appendicectomy can be safely performed in a carefully selected population with an appendiceal phlegmon.