Management of a large appendiceal abscess presenting as an abdominal wall collection: a case report

An appendiceal abscess represents a localized complication of acute appendicitis, resulting from a walled-off perforation. This is an appendiceal abscess presenting as an abdominal wall collection managed with bedside drainage. This case demonstrates that bedside drainage can be safe and effective in the absence of imaging in specific patients, providing a practical management option for resource-limited settings.

We report a case of a 36-year-old male who presented with 1 month of colicky periumbilical pain, fever, and a 1-week history of a painful swelling in the right lower abdomen. Physical examination revealed a tender, erythematous, and edematous mass measuring approximately 8 cm in diameter in the right iliac fossa. Under local anesthesia, bedside incision and drainage were performed, yielding 500 mL of thick pus, followed by irrigation with 1500 mL of normal saline. The wound was left open and dressed daily. Culture of the pus showed no bacterial growth, likely due to prior antibiotic exposure. The patient received empirical intravenous ceftriaxone and metronidazole, followed by oral amoxicillin-clavulanate and metronidazole upon discharge. Clinical recovery was uneventful, and he remained well on follow-up, declining the elective interval appendectomy.

This case demonstrates that conservative management with abscess drainage and antibiotics can achieve complete resolution of infection in an appendiceal abscess. Careful clinical monitoring and patient education are crucial to detect recurrence or residual disease.

Early recognition and prompt nonoperative management of appendiceal abscess can result in excellent outcomes and avoid unnecessary surgical morbidity. Individualized follow-up and selective interval appendectomy remain key components of long-term care.