Periappendiceal infiltrate - conservative therapy - retrospective data analysis and overview of literature

Acute appendicitis is a sudden inflammation of the appendix and is one of the most frequent causes of an acute abdominal pain, often requiring an urgent surgical procedure. A periappendiceal infiltrate is a complicated form of the acute appendicitis, identified by creation of an inflammatory mass of the tissue and organs of the abdominal cavity. The goals of our study were to identify patients diagnosed with a periappendiceal infiltrate, who were initially treated conservatively, evaluate the effectivity of such treatment, and compare our findings with both Czech and foreign literature.

A retrospective data analysis regarding patients with a conservatively treated periapendiceal infiltrate and/or abscess in our hospital during a five-year period (January 2020 - December 2024) and comparison of the results with Czech and foreign literature.

The number of patients with acute appendicitis in this period was 433, of which 13 (3.0%) were treated initially conservatively with intravenous antibiotics and were diagnosed with a periappendiceal infiltrate using imaging methods. There were 9 males (69.2%) and 4 females (30.8%), the average age was 57.7 years. A CT scan was initially performed in 12 of the patients (92.3%), 8 (61.5%) were found to have an abscess and 6 of the abscesses were treated via a CT-guided drainage. Twelve of the patients (92.3%) were treated successfully and without recurrence. Interval appendectomy was performed in 4 patients (30.8%).

Despite our study being limited in the number of patients, its results are coherent with the trend seen in foreign publications - the conservative approach using intravenous antibiotics with or without a CT-guided drainage is an adequate and effective treatment in patients with a periapendiceal infiltrate.