Abstract
Background/purpose
Perforated appendicitis is associated with abscess formation before or after appendectomy. Many abscesses are not amenable to drainage due to size or location. In this study, we compare patients who had a drain placed for an abscess to those who were treated without a drain.
Methods
Data were retrospectively collected from January 2000 to March 2011. Abscess before or after appendectomy was assessed. CT scans were reviewed and abscess size was estimated using the product of the greatest anteroposterior and lateral dimensions from an axial image. Patients with abscess smaller than 5 cm2 were excluded. Patients treated with a drain were compared to those without using t test for continuous variables and Fisher’s exact for categorical variables.
Results
Of 217 patients, those with drains had significantly more CT scans, total healthcare visits and larger abscess size. When match controlled for size, drain patients accrued more CT scans and healthcare visits. In a subset analysis of aspiration versus antibiotics only, there were more CT scans but no difference between length of stay, total healthcare visits, abscess size, recurrence, or complications.
Conclusions
Appendicitis-associated abscesses may be treated with antibiotics alone based on size, which improves resource utilization with fewer CT scans and healthcare visits.
This is a preview of subscription content, access via your institution.
References
Newman K, Ponsky T, Kittle K et al (2003) Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 38:372–379
St. Peter SD, Sharp SW, Holcomb III GW et al (2008) An evidence-based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg 43:2242–2245
Janik JS, Ein SH, Shandling B et al (1980) Nonsurgical management of appendiceal mass in late presenting children. J Pediatr Surg 15:574–576
Chen C, Botello C, Cooper A et al (2003) Current practice patterns in the treatment of perforated appendicitis in children. J Am Coll Surg 196:212–221
Morrow SE, Newman KD (2007) Current management of appendicitis. Semin Pediatr Surg 16:34–40
Owen A, Moore O, Marven S et al (2006) Interval laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech 16:308–311
Weiner DZ, Katz A, Hirschl RB et al (1995) Interval appendectomy in perforated appendicitis. Pediatr Surg Int 10:82–85
Okoye BO, Rampersad B, Marantos A et al (1998) Abscess after appendicectomy in children: the role of conservative management. Br J Surg 85:1111–1113
Forgues D, Habbig S, Diallo AF et al (2007) Post-appendectomy intra-abdominal abscesses-can they successfully be managed with the sole use of antibiotic therapy? Eur J Pediatr Surg 17:104–109
Heloury Y, Baron M, Bourgoin S et al (1995) Medical treatment of postappendecotmy intraperitoneal abscesses in children. Eur J Pediatr Surg 5:149–151
Piper HG, Derinkuyu B, Koral K et al (2011) Is it necessary to drain all postoperative fluid collections after appendectomy for perforated appendicitis? J Pediatr Surg 46:1126–1130
St Peter SD, Tsao K, Spilde TL et al (2008) Single daily dosing ceftriaxone and metronidazole vs. standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg 43:981–985
Fraser JD, Aguayo P, Leys CM et al (2010) A complete course of intravenous antibiotics vs. a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. J Pediatr Surg 45:1198–1202
Fike FB, Mortellaro VE, Juang D et al (2011) The impact of postoperative abscess formation in perforated appendicitis. J Surg Res 170:24–26
Keckler SJ, St. Peter SD, Tsao K et al (2008) Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis. J Pediatr Surg 43:977–980
St. Peter SD, Aguayo P, Fraser JD et al (2010) Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg 45:236–240
Jamieson DH, Chait PG, Filler R (1997) Interventional drainage of appendiceal abscesses in children. AJR Am J Roentgenol 169:1619–1622
Van Sonnenberg E, Mueller PR, Ferrucci JT (1984) Percutaneous drainage of 250 abdominal abscess and fluid collections. Radiology 151:337–341
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gasior, A.C., Marty Knott, E., Ostlie, D.J. et al. To drain or not to drain: an analysis of abscess drains in the treatment of appendicitis with abscess. Pediatr Surg Int 29, 455–458 (2013). https://doi.org/10.1007/s00383-013-3262-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-013-3262-3
Keywords
- Appendicitis
- Abscess
- Drainage
- Pediatric