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Medical treatment of postappendectomy intraperitoneal abscesses in children
Y Héloury1, M Baron, S Bourgoin
1Chirurgie Infantile, Hôpital Mère-Enfant, Nantes, France.
Insights
Exclusively medical treatment for pediatric postappendectomy intraperitoneal abscesses is effective. This approach, using antibiotics, resolved abscesses in most children, avoiding surgery unless complications like ileus arise.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Medical Imaging
Background:
- Postappendectomy intraperitoneal abscesses traditionally require surgical drainage.
- Limited data exists on non-surgical management in pediatric cases.
Purpose of the Study:
- To evaluate the efficacy of exclusive medical management for isolated postappendectomy abscesses in children.
- To assess the role of antibiotic therapy and ultrasonography in treatment monitoring.
Main Methods:
- Retrospective study of 11 children treated medically between 1988-1991.
- Parenteral and oral antibiotic regimens were utilized.
- Ultrasonography was used for abscess localization and treatment follow-up.
Main Results:
- Medical treatment resolved abscesses in 10 out of 11 children.
- Clinical signs improved within the first week of treatment.
- One patient required reoperation due to associated ileus.
Conclusions:
- Exclusive medical treatment is a viable option for isolated postappendectomy abscesses in children.
- Abscess resolution was confirmed by ultrasonography.
- Surgical intervention may be necessary for cases with complications such as ileus.
Abstract:
Treatment of postappendectomy intraperitoneal abscesses is classically surgical (drainage). We report a retrospective study (1988 to 1991) of our experience in providing exclusively medical treatment for 11 such isolated abscesses in children. The abscess was detected 7 times within the 10 days following appendectomy. Ultrasonography localized the abscess 7 times in the right iliac fossa and 4 times in Douglas' pouch. In 4 cases it was larger than 5 cm in diameter. Parenteral antibiotic therapy associated ticarcillin and clavulanic acid 6 times and piperacillin, tobramycin and metronidazole 5 times. Drug efficacy was evaluated by clinical signs (fever, pain, ileus) and ultrasonography. In one case, an associated ileus led to reoperation at day 4 of treatment. In the other 10 cases, clinical signs disappeared during the first week of treatment. At day 7, parenteral was replaced by oral antibiotic therapy (metronidazole 7 times, amoxicillin-clavulanic acid 3 times) continued until the abscess was no longer visualized on ultrasonography (5 times at 3 weeks, 5 times at 1 month). Medical treatment of isolated postappendectomy abscesses in children would thus appear to be a logical choice in the absence of an associated ileus.