Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective. Issue 10 (8th June 2020)

• Record Type: Journal Article
• Authors: Collins, Geoffrey; Allaway, Matthew G. R.; Eslick, Guy D.; Cox, Michael R.
• Is Part Of: ANZ journal of surgery. Volume 90:Issue 10(2020)
• Page Start: 1979
• Page End: 1983
• Publication Date: 2020-06-08
• Subjects: appendicectomy -- intra‐abdominal abscess; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.16023
• Languages: English
• ISSNs: 1445-1433

Abstract

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 post‐appendicectomy 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 post‐appendicectomy can be safely and effectively managed non‐operatively. Abstract : There is little published data on the non‐operative management of small post‐appendicectomy intra‐abdominal abscesses. Twenty‐six small (<4 cm diameter) post‐appendicectomy intra‐abdominal abscesses were all successfully managed non‐operatively.