The management of appendicular abscesses in a Tunisian Tertiary Care Hospital

Abstract

Background This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management. Methods This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi2 test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05. Results The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4–24 weeks) and was uneventful. Conclusion Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.

Laparoscopic Drainage Versus Interventional Radiology for Management Of Appendicular Abscess : A Randomized Controlled Trial

“…Size of appendicular abscess ranged from small, moderate and large size in both groups., small size abscess (1-2cm) occurred in 22 (25.6%) patients, moderate size (2-4cm) according to radiological classi cation (14) occurred in 30 (34.9%) patients, large size (4-7cm) occurred in 34(39.5%) patients this in group (1). Small size abscess (1-2cm) occurred in 18(20.9%) patients, moderate size occurred in 34(39.5%) patients, large size 34(39.5%), in group (2) as in table (1).…”

Relationship between Degree of Dependency and Hospitalization Time of Surgical Patients

“…The latter has greater benefits because it is a less-invasive procedure, causes les pain in patients, occurrence of infection at the surgical site is reduced, patients require shorter hospitalization periods, the reincorporation to their daily life activities is undertaken without major implications, with an intact level of independence and with limited assistance from nursing care; therefore, in general terms, it is considered the safest technique, but both must be analyzed according to the characteristics of the patient and the availability of the human resources that provide care. (19)(20)(21) Without risks and without complications, these aspects will determine an ephemeral hospitalization of patients, however, nursing professionals must be prepared for all possible scenarios upon knowing the surgical intervention trends and the care needs of patients, according to their degree of dependency, to optimize care and ensure the speedy recovery of those affected.…”