Risk factors for intra-abdominal abscess formation after appendectomy: a multicenter retrospective cohort study from...

Postoperative intra-abdominal abscess (IAA) remains a significant cause of morbidity after appendectomy, particularly in low-resource settings where delayed presentation and advanced disease are common. This study aimed to identify factors associated with postoperative IAA formation after appendectomy in an African setting and to evaluate management strategies and outcomes.

A multicenter retrospective cohort study was conducted across three tertiary hospitals in Mogadishu, Somalia. All patients who underwent appendectomy between January 2024 and July 2025 were screened for eligibility. Demographic, clinical, intraoperative, and postoperative variables were collected from medical records. The primary outcome was the development of an intra-abdominal abscess within 30 days after appendectomy. Patients with and without postoperative IAA were compared.

Ninety-two patients were included, of whom 19 patients (20.7%) developed postoperative IAA. Delayed presentation beyond 48 h was significantly more frequent in the abscess group than in the non-abscess group (94.7% vs. 30.1%, p < 0.001). Perforated appendicitis and the presence of an appendicolith were strongly associated with IAA formation. Operative duration longer than 60 min and drain placement were also more common among patients with IAA. These patients experienced longer hospital stays and higher rates of wound infection and sepsis. Most postoperative IAA were managed successfully with antibiotics alone in selected cases (13/19, 68.4%).

Postoperative IAA formation after appendectomy in this low-resource setting was strongly associated with delayed presentation and advanced disease severity. Improving early access to surgical care and optimizing perioperative management may reduce postoperative morbidity.