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Postappendectomy fluid collections in children: incidence, nature, and evolution evaluated using US
Insights
Postoperative fluid collections after appendectomy in children are often managed conservatively. Pelvic fluid collections typically resolve without surgery, while widespread abscesses may require drainage.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Postappendectomy fluid collections are a known complication.
- Conservative management is common, but criteria for intervention require clarification.
Purpose of the Study:
- To evaluate the incidence and outcomes of postoperative fluid collections in children following appendectomy.
- To assess the role of sonography in monitoring these collections.
Main Methods:
- Retrospective review of 216 pediatric appendectomy cases.
- Postoperative sonography was performed on 32 patients (15%).
- Analysis of fluid collection characteristics, management, and resolution time.
Main Results:
- 10 patients (31%) had 16 fluid collections on initial sonography.
- 7 patients with pelvic collections showed conservative treatment success (2-9 weeks resolution).
- 3 patients developed abscesses requiring surgical drainage; 2 had severe, widespread disease.
Conclusions:
- Clinically significant fluid collections occur in ~5% of pediatric appendectomy cases.
- Sonography is valuable for monitoring fluid collection size and progression.
- Pelvic fluid collections often resolve with conservative, nonoperative management.
Abstract:
At the authors' medical center, most patients with postappendectomy fluid collections are treated conservatively. Thirty-two (15%) of 216 children underwent postoperative sonography following appendectomies. In ten patients (31%), a total of 16 fluid collections were found on the initial postoperative sonogram. In the seven patients (70%) whose fluid collections were confined to the pelvis, the condition was treated conservatively and it resolved in 2-9 weeks. In three patients, fluid collections required surgical drainage and proved to be abscesses. In two of the three patients, abscesses were multiple and widely distributed in the abdomen, and the patients were clinically ill. The authors conclude that clinically symptomatic fluid collections develop postoperatively in approximately 5% of children who have undergone appendectomy for acute appendicitis and that the size and course of the fluid collection can be objectively monitored using sonography. Such fluid collections confined to the pelvis ultimately resolve with conservative, nonoperative therapy, although resolution may take up to 2 months.