Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

Abstract

Background: Intra-abdominal abscess (IAA) post-appendicectomy occurs in 1.4-4.4% of cases. Non-operative management of small (<4 cm) post-appendicectomy IAA in children is well established, but minimal evidence exists in adults. Percutaneous catheter drainage is considered standard treatment for IAA, yet outcome data for post-appendicectomy IAA are sparse. The aims of this study were to assess the effectiveness of non-operative management of small (<4 cm diameter) IAA and the outcomes of percutaneous drainage for larger (>4 cm) IAA post-appendicectomy. Methods: A retrospective case note review of a series of patients with a postappendicectomy IAA between 2006 and 2017 was conducted. IAAs were treated selectively; small (<4 cm) IAAs were managed non-operatively and larger IAAs were managed with percutaneous drainage. Results: A total of 4901 patients had an appendicectomy. Forty-two (0.9%) developed a post-operative IAA. Sixteen (38%) had a percutaneous drainage and 26 (62%) had non-operative management. The percutaneous drainage group had a higher proportion of complicated appendicitis (75%) compared to the non-operative group (42%, P = 0.04). The percutaneous drainage group had a significantly higher leucocytosis (P = 0.01) and C-reactive protein (P = 0.02). All patients managed non-operatively resolved without the need for invasive procedures. In the percutaneous drainage group, six had aspiration alone, nine had a percutaneous drain and one was abandoned. Three required repeat percutaneous drainage and four (25%) required operative drainage. Seven patients (34%) of the percutaneous drainage group had grade II or III complications. Conclusion: This case series study provides support that small (<4 cm) IAA postappendicectomy can be safely and effectively managed non-operatively.

The Management of Post-appendectomy Abscess in Children; A Historical Cohort Study and Update of the Literature

“…The treatment of PAA smaller than 3 cm is less subject of debate in children. Although historically, especially in adults, invasive treatment procedures for PAA were preferred, several more recent studies have reported promising results of non-operative treatment of small PAA with treatment successes ranging between 84 and 100% ( 6 , 12 , 18 – 20 ). This is in line with the results of our multicenter cohort, in which all patients with PAA smaller than 3 cm were successfully treated with a non-invasive treatment strategy.…”

Periumbilical giant abscess and intestinal leakage in late pregnancy: A rare case report and literature review

“…It is more common in acute and chronic inflammation, stones and tumors in the internal organs of the abdominal cavity, as well as perforation and rupture of the digestive tract. [2,3] Periappendiceal abscess caused by conservative treatment of chronic appendicitis and appendectomy is not uncommon in clinically practice, but the cases of abdominal wall abscesses following appendectomy are relatively rare, and it is even rarer in the third trimester. From January 1980 to September 2021, Pubmed searched the literature published and there were no reports of “pregnancy” and “periumbilical abscess.”…”

Image-Guided Percutaneous Drainage of Abdominal Abscesses in Pediatric Patients

“…Combining medical therapy with invasive procedures is required as IV antibiotics generally do not reach effective concentrations within abscess cavities except in small immature abscesses [ 2 , 38 ]. Abscesses measuring 1–4 cm in diameter may occasionally resolve themselves by means of antibiotic treatment alone and, thus, warrant a wait-and-see approach [ 2 , 17 , 39 ]. A more aggressive approach should be based on the clinical course of disease.…”