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[Abscesses after appendectomy due to intraoperative retaining of fecalith]
M Hörmann1, S Kreuzer, P Sacher
1Universitätsklinik für Radiodiagnostik, Abteilung chirurgische Facher, AKH Wien, Osterreich. marcus.hoermann@akh-wien.ac.at
Insights
Fecaliths, hard stool masses, can lead to appendicitis, abscesses, and perforation in children. Early imaging detection of fecaliths is crucial for surgical planning and preventing complications like retained fecaliths after appendectomy.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Surgery
Background:
- Fecaliths are associated with increased risk of acute appendicitis, abscess formation, and perforation.
- Preoperative radiological evaluations are increasingly utilized, but immediate surgery is common for suspected perforation in children.
Purpose of the Study:
- To report and discuss imaging findings and implications of fecaliths in children with acute appendicitis.
- To highlight the importance of detecting fecaliths in preoperative imaging.
Main Methods:
- Retrospective review of four pediatric patients (mean age 9 years) with acute appendicitis and fecaliths.
- Sonography and plain radiography were used for diagnosis, with all patients undergoing imaging after readmission.
Main Results:
- Fecaliths were initially diagnosed in 3 of 4 patients.
- All 4 patients experienced recurrent abdominal pain and required readmission.
- Sonography and plain radiography demonstrated escaped fecaliths, confirmed surgically.
Conclusions:
- The role of imaging in acute appendicitis should extend beyond diagnostic yield of cross-section techniques.
- Detecting fecaliths prompts a more thorough intraoperative search.
- Radiologists must be aware of retained fecaliths as a cause of post-appendectomy abscess formation.
Objective:
Fecaliths appear to predispose a patient to acute appendicitis, abscess formation, and perforation. The number of preoperative radiological evaluations is increasing, although children with suspected perforation still undergo surgery immediately. We report and discuss imaging findings and implications in children with acute appendicitis and fecaliths.
Methods:
Four children (3 girls, 1 boy; mean age 9 years) underwent surgery for acute appendicitis. Three children underwent sonography and plain radiography before surgery, 1 child was operated without radiological evaluation. After readmission, all 4 children underwent sonography and plain radiography before surgery.
Results:
In 3 patients a fecalith was diagnosed initially. After uneventful recovery all 4 patients had acute abdominal pain and readmission was necessary. In all 4 patients the escaped fecalith was demonstrated with sonography and plain radiography confirmed surgically.
Conclusion:
Discussion about the role of imaging in acute appendicities has concentrated on the diagnostic yield of cross-section techniques. The importance of demonstrating a fecalith, prompting a more thorough intraoperative search has found little attention. The radiologist should also detect and localize a fecalith and should be aware of retained fecaliths as a cause of abscess formation after appendectomy.