Initial nonoperative management for periappendiceal abscess

Oliak, David; Yamini, Dan; Udani, Vikram M.; Lewis, Roger J.; Arnell, Tracey D.; Vargas, Hernan I.; Stamos, Michael J.

doi:10.1007/bf02235479

Cited by 118 publications

(103 citation statements)

References 18 publications

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“…This number is similar to what Eriksson reports in his study [17]. In a recent study, Oliak et al [24]found that the complication rate for interval appendectomy was 16%.…”

Section: Discussionsupporting

confidence: 78%

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

Willemsen¹,

Hoorntje

Eddes

et al. 2002

Dig Surg

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Background: Our current treatment of an appendiceal mass is initially conservative, followed by an interval appendectomy. The necessity of this routine interval appendectomy is debatable. A study was conducted to evaluate whether surgical factors and pathological features of the excised appendices support interval appendectomy. Methods: We performed a retrospective study at the University Hospital Groningen and the Deventer Ziekenhuis. All patients diagnosed with an appendiceal mass in the period January 1991 to January 1997 were identified using the hospital database. The medical records of all these patients (n = 233, 108 M, 125 F) were reviewed. The clinical course of the appendiceal mass patients was split up into three distinct episodes: initial diagnosis and treatment of the appendiceal mass, the interval period and the interval appendectomy. Presenting symptoms, findings at clinical examination and additional imaging (ultrasound) were registered, as well as the course of the primary hospitalisation, the interval period, and the interval appendectomy. Results of histological examination of all resected specimens were reviewed. Results: It was found that clinical findings alone were not specific enough to diagnose an appendiceal mass; 47% had a palpable abdominal mass and the median temperature was 38.2°C ranging from 36 to 40.5°C. Ultrasound examination was done in 69% of patients and showed an appendiceal mass in 72%. During the interval period, 4 patients presented with an appendiceal mass needing drainage, and 3 with acute appendicitis requiring emergency appendectomy. At interval appendectomy, histological examination of resection specimen showed a normal appendix without signs of previous inflammation in 30% of cases. In addition, complications due to interval appendectomy were seen in 18% of patients, including sepsis, bowel perforation, small bowel ileus, and various wound abscesses. Conclusions: We conclude that when causes for the appendiceal mass other than appendicitis are excluded, interval appendectomy seems unnecessary in patients who respond well to initial conservative treatment.

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“…This number is similar to what Eriksson reports in his study [17]. In a recent study, Oliak et al [24]found that the complication rate for interval appendectomy was 16%.…”

Section: Discussionsupporting

confidence: 78%

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

Willemsen¹,

Hoorntje

Eddes

et al. 2002

Dig Surg

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“…The non-surgical approach is an effective strategy for managing appendiceal abscess in children and adults [10][11][12][13] . The success rate of this approach is relatively high, ranging from 80% to 95% 2,3) .…”

Section: Discussionmentioning

confidence: 99%

Prediction of Negative Outcomes in Non-Surgical Treatment for Appendiceal Abscess in Adults

Sadakari

Date

Murakami

et al. 2018

J Anus Rectum Colon

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Abstract:Objectives: Non-surgical treatment is an acceptable approach for managing appendiceal abscess in adults. However, it is only applicable for selected patients, and conversion to surgery is mandatory for failed conservative treatment. This study aimed to determine the predictive factors for unsuccessful outcomes. Methods: Of 594 patients with acute appendicitis, 34 (5.7%) diagnosed with appendiceal abscess were initially treated conservatively. Patients were divided into two groups: the conservative group, which was successfully treated with antibiotics and percutaneous abscess drainage, and the conversion group, which comprised patients who had surgical conversion despite conservative treatment. Risk factors for the conversion group were investigated by comparing clinical and radiological parameters between the two groups. Results: Eight (23.4%) patients were converted to surgical management at an average of 5.5 days of non-surgical treatment. An abscess size greater than 40 mm and a lower rate of improvement in the white blood cell (WBC) count were significant factors for predicting conversion in multivariate analysis. The conversion group had a long operative time and high morbidity and operative conversion rates (change of proposed initial operation). Early conversion to operation group, i.e., less than 5 days of treatment, contributed to a significantly shorter hospital stay, lower hospital cost, and relatively shorter operative time (p = 0.02, p = 0.04, and p = 0.11, respectively). Conclusions: Contributing factors in predicting unsuccessful outcomes for nonsurgical treatment include an abscess size greater than 40 mm and a low rate of improvement in WBC count on the first day of antibiotic treatment.

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“…Nonoperative treatment is a safe and effective response to complicated AA (11,12); however, this concept is a contentious point among medical professionals because of the potential need for interval appendectomy (IA). IA is the surgical removal of the appendix 6-8 weeks following nonoperative treatment for complicated AA.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of nonoperative treatment for uncomplicated acute appendicitis

Kırkıl¹,

Yiğit²,

Aygen³

2014

Turk J Gastroenterol

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Background/Aims: This study aimed to assess the long-term (>12 months) efficacy of nonoperative treatment (antibiotic administration) in the management of uncomplicated acute appendicitis (AA). Materials and Methods: We surveyed uncomplicated AA patients who elected to undergo nonoperative treatment between 2010 and 2012. A binary logistic regression analysis was performed to identify the critical predictors of recurrence. Age, gender, presence of appendicolith, and white blood cell count on admission were analyzed as possible predictors of recurrence. Results: The median follow-up period of the study was 23 months. Twelve of 118 patients (10.2%) were diagnosed with recurrent appendicitis. Seven were retreated with the same antibiotic protocol and did not show further recurrence. The binary logistic regression analysis revealed statistical significance only for the presence of appendicolith [P=0.001, Exp (B)=0.058, B=-2.845]. Recurrence rate was lower in the presence of appendicolith. Conclusion: Nonoperative treatment of uncomplicated AA is an effective option. Recurrence is rare and it can be addressed efficiently with the administration of a second course of antibiotics. The presence of appendicolith should not discourage physicians from prescribing nonoperative treatment for patients with uncomplicated AA.

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Initial nonoperative management for periappendiceal abscess

Abstract: Initial nonoperative management of appendicitis complicated by periappendiceal abscess is safe and effective. Patients undergoing initial nonoperative management have a lower rate of complications, but they are at risk for recurrent appendicitis.

Cited by 118 publications

References 18 publications

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

Prediction of Negative Outcomes in Non-Surgical Treatment for Appendiceal Abscess in Adults

Long-term results of nonoperative treatment for uncomplicated acute appendicitis

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