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Abstract:
Of 61 patients with appendiceal abscess, 32 were treated by incision and drainage without appendectomy, with 16% morbidity. Seventeen patients had incision and drainage with appendectomy, with 24% morbidity. One patient, admitted in septic shock, died without operation. Average hospitalization was shortest in the nine patients treated nonoperatively. Many patients with appendiceal mass or abscess do not require immediate operation. In the 42 patients discharged without appendectomy, the recurrence rate of appendicitis was 5% at 9.1 months' average follow-up. Thirty-two elective interval appendectomies were performed at an average interval of 96 days, with 13% morbidity. At interval appendectomy, those patients from whom a free fecalith had been removed at the time of drainage had the greatest degree of appendiceal destruction. Interval appendectomy is probably not necessary in such patients.
Insights
Many patients with appendiceal abscess can be treated nonoperatively or with drainage alone, avoiding immediate appendectomy. Recurrence rates are low, suggesting interval appendectomy may not be necessary for all patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Appendiceal abscess and mass are common surgical emergencies.
- Optimal management strategies remain under investigation.
Purpose of the Study:
- To evaluate the outcomes of different management strategies for appendiceal abscess.
- To determine the necessity of immediate or interval appendectomy.
Main Methods:
- Retrospective review of 61 patients with appendiceal abscess.
- Comparison of outcomes for nonoperative management, incision and drainage (I&D) with and without appendectomy, and interval appendectomy.
Main Results:
- Nonoperative management and I&D without appendectomy showed lower morbidity (16%) compared to I&D with appendectomy (24%).
- Average hospitalization was shortest for nonoperatively treated patients.
- Recurrence rate of appendicitis after non-operative management was 5% with a 9.1-month follow-up.
- Morbidity for elective interval appendectomy was 13%.
Conclusions:
- Many patients with appendiceal abscess or mass do not require immediate surgical intervention.
- Nonoperative management or drainage alone can be effective, with low recurrence rates.
- Interval appendectomy may not be necessary in all cases, particularly when fecaliths are removed during initial drainage.