Laparoscopic Drainage of Postappendectomy- Retained Fecalith and Intra-abdominal Abscess in the Pediatric Population

Abstract

Retained fecalith after an appendectomy is an uncommon complication frequently associated with intra-abdominal abscess. Treatment options include percutaneous, open, or laparoscopic drainage of the abscess and retrieval of the fecalith, as antibiotics and drainage alone are usually insufficient. Laparoscopy offers the advantages of enhanced visualization of the abdomen, improved cosmesis, and a quicker return to normal daily activities. The principles of laparoscopic treatment include the careful identification of all anatomic landmarks, as the abscesses are frequently adherent to intra-abdominal structures compromising the safety of the operation. In this paper, we present 2 cases of laparoscopic drainage of an intra-abdominal abscess with retrieval of a fecalith in pediatric patients 1 and 6 weeks after an initial appendectomy and a review the literature.

Perihepatic abscess caused by dropped appendicoliths following laparoscopic appendectomy: Sonographic findings

“…As reported by Paya et al, appendicoliths may be associated with increased risk of appendiceal perforation in the pediatric population . Most of the 27 cases in which intra‐abdominal abscess formation secondary to dropped or retained appendicoliths were reported occurred during laparoscopic appendectomy . Dropped or retained intra‐abdominal appendicoliths can serve as a nidus for abscess formation, which can occur days to months after surgery.…”

“…Typical management of this complication involves the drainage of the abscess and the extraction of appendicoliths. Extraction may be performed with a percutaneous, open, or laparoscopic approach . Also, in our case, the size of the abscess was small enough to be treated conservatively; however, the surgeon advised percutaneous or surgical extraction should the infection recur.…”

Early Laparoscopic Washout may Resolve Persistent Intra‐abdominal Infection Post‐appendicectomy

“…Similarly, there are limited data for the outcomes of laparoscopic treatment of intra-abdominal collections postappendicectomy [22][23][24][25]. These are a case report [22] and three small retrospective case series [23][24][25].…”

“…Although there are reports where laparoscopic washout has been employed successfully in patients with intra-abdominal sepsis following appendicectomy, there is a lack of evidence regarding its efficacy. To date, the available evidence is predominantly from the paediatric population comprising a case report [22] and three small case series, the largest of which included twelve patients [23][24][25].…”

Laparoscopic drainage of intraabdominal abscess after appendectomy: an alternative to laparotomy in cases not amenable to percutaneous drainage

“…Although laparoscopy is being used more frequently to treat abscesses in adults with complicated diverticular abscesses, reports of its use for this purpose in the pediatric population are limited [6,7].…”