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Treatment of post-appendectomy intra-abdominal deep abscesses

E Dobremez1, F Lavrand, Y Lefevre

  • 1Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. Eric.Dobremez@wanadoo.fr

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|January 27, 2004
PubMed

Insights

Antibiotic therapy is more effective than surgery for treating pediatric intra-abdominal abscesses after appendectomy. Medical management leads to shorter hospital stays and fewer complications, making it a preferred treatment option.

Area of Science:

  • Pediatric Surgery
  • Infectious Diseases
  • Gastroenterology

Background:

  • Intra-abdominal abscesses are a known complication following appendectomy in children.
  • Traditional management involves surgical drainage, which can be associated with significant morbidity.

Purpose of the Study:

  • To compare the efficacy of antibiotic management versus surgical treatment for intra-abdominal abscesses post-appendectomy in pediatric patients.
  • To evaluate complication rates and hospital stay duration between the two treatment modalities.

Main Methods:

  • Retrospective study of 22 children (ages 5-13) treated for post-appendectomy intra-abdominal abscesses (1992-2002).
  • Eleven patients received surgical drainage; eleven received triple antibiotic therapy.
  • Comparison of treatment success, complication rates, and average hospital stay.

Main Results:

  • Surgical treatment was effective in only 36% of cases, with a 64% complication rate (including fistula, recurrent abscess, gangrene, septic shock) and an average hospital stay of 16.7 days.
  • Antibiotic therapy was effective in 91% of cases, with a shorter average hospital stay of 10.4 days and fewer complications.
  • One patient in the antibiotic group required surgery for a recurrent abscess due to a residual stercolith.

Conclusions:

  • Medical management with antibiotics appears to be a highly effective treatment for pediatric intra-abdominal abscesses after appendectomy.
  • Antibiotic therapy is associated with shorter hospitalizations and reduced complication rates compared to surgery.
  • Antibiotic management is recommended except in cases with residual foreign bodies, stercoliths, poor patient status, or septic shock.

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