Conservative versus operative treatment of appendicular abscess. Experience of 147 consecutive patients

One hundred and forty-seven consecutive patients who were treated for appendicular abscess were studied retrospectively, to evaluate conservative and operative treatment. 69 patients (47%) were primarily treated conservatively; of them six (9%) had to be operated on in the acute phase because of worsening of the symptoms. 78 patients (53%) were operated on primarily. Of them, 22 (28%) had complications, five (6%) needed a reoperation. Interval appendicectomy was performed in 45 patients (31%) 2-6 months after conservative treatment, and all healed well. Eighteen patients (12%) were treated conservatively only. Colography was performed in 48 patients after conservative treatment. In four, a tumour was suspected, but at operation no tumour was found in any of them. However, one caecal carcinoma was found at the interval appendicectomy, but in this case the colography did not reveal the tumour. In addition, five cases of Crohn's disease and one of diverticulitis were detected. Our findings suggest that if appendicular abscess is operated on in the acute phase, there may be more complications, but it is often not possible to make the correct diagnosis before operation. The routine of interval appendicectomy may be questioned, but adequate follow-up should be arranged. Laparotomy is indicated without delay when there is clinical suspicion of cancer, even if the colography does not reveal a tumour. For young asymptomatic patients conservative treatment with sufficient follow-up might be sufficient.