Initial nonoperative management for periappendiceal abscess
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
PURPOSE: Our goal was to compare initial operative and nonoperative management for periappendiceal abscess complicating appendicitis. METHODS: This study is a retrospective review of 155 consecutive patients with appendicitis complicated by periappendiceal abscess treated between 1992 and 1998. Eighty-eight patients were treated initially nonoperatively, and 67 patients were treated operatively. All patients had localized abdominal tenderness and either computed tomography or intraoperative documentation of an abscess. RESULTS: Our patient population consisted of 107 males and 48 females, with an average age of 33 (range, 16–75) years. Age, gender, comorbidity, white blood cell count, temperature, and heart rate did not differ significantly between groups. For the initial nonoperative management group, the failure rate was 5.8 percent and the appendicitis recurrence rate was 8 percent after a mean follow-up of 36 weeks. The response to treatment of the initial nonoperative group and the initial operative group was compared by length of stay (9±5 daysvs. 9±3 days;P=not significant), days until white blood cell count normalized (3.8±4 daysvs. 3.1±3 days;P=not significant), days until temperature normalized (3.2±3 daysvs. 3.1±2 days;P=not significant), and days until a regular diet was tolerated (4.7±4 daysvs. 4.6±3 days;P=not significant). Complication rate was significantly lower in the nonoperative group (17vs. 36 percent;P=0.008). CONCLUSIONS: Initial nonoperative management of appendicitis complicated by periappendiceal abscess is safe and effective. Patients undergoing initial nonoperative management have a lower rate of complications, but they are at risk for recurrent appendicitis.
- Fitz RH. Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment. Am J Med Sci 1886;92:321–46.
- McBurney C. Experiences with early operative interference in cases of disease of the vermiform appendix. N Y Med J 1889;50:676–84.
- Condon RE. Appendicitis. In: Sabiston DC Jr, ed. Textbook of surgery. 10th ed. Philadelphia: JB Lippincott, 1972.
- Allen JG. Appendicitis, peritonitis, and intra-abdominal abscesses. In: Rhoads JE, Allen JG, Harkins HN,et al., eds. Surgery principles and practice. 4th ed. Philadelphia: JB Lippincott, 1970.
- Bradley EL III, Isaacs J. Appendiceal abscess revisited. Arch Surg 1978;113:1144–5.
- Paull DL, Bloom P. Appendiceal abscess. Arch Surg 1982;117:1017–9.
- Jordan JS, Kovalcik PJ, Schwab CW. Appendicits with a palpable mass. Ann Surg 1981;193:227–9.
- McPherson A, Kinmonth J. Acute appendicitis and the appendix mass. Br J Surg 1945;32:365–70.
- Thomas DR. Conservative management of the appendix mass. Surgery 1973;73:677–80.
- Skoubo-Kristensen E, Hvid I. The appendiceal mass: results of conservative management. Ann Surg 1982;196:584–7.
- Mosegaard A, Nielsen OS. Interval appendectomy: a retrospective study. Acta Chir Scand 1979;145:109–11.
- Bagi P, Dueholm S. Nonoperative management of the ultrasonically evaluated appendiceal mass. Surgery 1987;101:602–5.
- Hoffman J, Lindhard A, Jensen HE. Appendix mass: conservative management without interval appendectomy. Am J Surg 1984;148:379–82. CrossRef
- Nitecki S, Assalia A, Schein M. Contemporary management of the appendiceal mass. Br J Surg 1993;80:18–20.
- Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994;190:31–5.
- Lane MJ, Katz DS, Ross BA, Clautice-Engle TL, Mindelzun RE, Jeffrey RB. Unenhanced helical CT for suspected acute appendicitis. AJR Am J Roentgenol 1997;168:405–9.
- Rao PM, Rhea JT, Novelline RA,et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination. Radiology 1997;202:139–44.
- Rao PM, Rhea JT, Novelline RA. Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 1997;21:686–92. CrossRef
- Gale ME, Birnbaum S, Stephen GG, Sloan G, Johnson W, Robbins AH. CT appearance of appendicitis and its local complications. J Comput Assist Tomogr 1985;9:34–7.
- Balthazar EJ, Megibow AJ, Hulnick D, Gordon RB, Naidich DP, Beranbaum ER. CT of appendicitis. AJR Am J Roentgenol 1986;147:705–10.
- Rao PM, Mueller PR. Clinical and pathologic variants of appendiceal disease: CT features. AJR Am J Roentgenol 1998;170:1335–40.
- Rao PM, Rhea JT, Novelline RA. Appendiceal and periappendiceal air at CT: prevalence, appearance and clinical significance. Clin Radiol 1997;52:750–4. CrossRef
- Oliak D, Sinow R, French S, Udani VM, Stamos MJ. Computed tomography scanning for the diagnosis of perforated appendicitis. Am Surg 1999;65:959–64.
- van Sonnenberg E, Wittich GR, Casola G,et al. Periappendiceal abscesses: percutaneous drainage. Radiology 1987;163:23–6.
- Flancbaum L, Nosher JL, Brolin RE. Percutaneous catheter drainage of abdominal abscesses associated with perforated viscus. Am Surg 1990;56:52–6.
- Vargas HI, Averbook A, Stamos MJ. Appendiceal mass: conservative therapy followed by interval laparoscopic appendectomy. Am Surg 1994;60:753–8.
- Yamini D, Vargas H, Bongard F, Klein S, Stamos M. Perforated appendicitis: is it truly a surgical urgency? Am Surg 1998;64:970–5.
- Oliak D, Yamini D, Udani VM,et al. Nonoperative management for perforated appendicitis without periappendiceal mass. Am J Surg 2000;182:1382–8.
- Verwaal VJ, Wobbes T, Goris RJ. Is there still a place for interval appendectomy? Dig Surg 1993;10:285–8.
- Initial nonoperative management for periappendiceal abscess
Diseases of the Colon & Rectum
Volume 44, Issue 7 , pp 936-941
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Interval appendectomy
- Percutaneous abscess drainage
- Industry Sectors
- Author Affiliations
- 1. From the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
- 2. Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- 3. Division of Colon and Rectal Surgery, 1000 West Carson Street, Box 25, 90509, Torrance, California