Is there a role for routine abdominal imaging in predicting postoperative intraabdominal abscess formation after appendectomy for pediatric ruptured appendix?

Abstract

To determine if there is a role for routine abdominal imaging in predicting postoperative intraabdominal abscess after appendectomy for the pediatric ruptured appendix. From January 2000 to December 2003 inclusive, 44 consecutive pediatric patients with a ruptured appendix had an open appendectomy and were treated for a minimum of 5 days with triple antibiotics. On postoperative day 5, each patient was evaluated for symptoms (fever, abdominal pain, gastrointestinal dysfunction) and radiological evidence of an intraabdominal fluid collection. Further treatment was determined by the clinical evidence of continuing infection. On postoperative day 5, 36 (82%) of the 44 patients were asymptomatic, had an intraabdominal fluid collection less than 5 cm, diagnosed by ultrasound or computed tomography and received no further treatment. Two of these 36 patients (6%) returned within a week, symptomatic and with a larger collection suspicious for an intraabdominal abscess and requiring further treatment. The other 8 (18%) were symptomatic, and had an intraabdominal abscess more than 5 cm on imaging. All required further treatment, and recovered well. The use of routine abdominal imaging on postoperative day 5, (compared with clinical evaluation), did not improve the ability to predict the development of an intraabdominal abscess.