Skip to main content

To drain or not to drain: an analysis of abscess drains in the treatment of appendicitis with abscess



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.


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.


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.


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.


  1. 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

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. Janik JS, Ein SH, Shandling B et al (1980) Nonsurgical management of appendiceal mass in late presenting children. J Pediatr Surg 15:574–576

    Article  PubMed  CAS  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Morrow SE, Newman KD (2007) Current management of appendicitis. Semin Pediatr Surg 16:34–40

    Article  PubMed  Google Scholar 

  6. Owen A, Moore O, Marven S et al (2006) Interval laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech 16:308–311

    Article  Google Scholar 

  7. Weiner DZ, Katz A, Hirschl RB et al (1995) Interval appendectomy in perforated appendicitis. Pediatr Surg Int 10:82–85

    Article  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. 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

    Article  PubMed  CAS  Google Scholar 

  10. Heloury Y, Baron M, Bourgoin S et al (1995) Medical treatment of postappendecotmy intraperitoneal abscesses in children. Eur J Pediatr Surg 5:149–151

    Article  PubMed  CAS  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. Fike FB, Mortellaro VE, Juang D et al (2011) The impact of postoperative abscess formation in perforated appendicitis. J Surg Res 170:24–26

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. Jamieson DH, Chait PG, Filler R (1997) Interventional drainage of appendiceal abscesses in children. AJR Am J Roentgenol 169:1619–1622

    Article  PubMed  CAS  Google Scholar 

  18. Van Sonnenberg E, Mueller PR, Ferrucci JT (1984) Percutaneous drainage of 250 abdominal abscess and fluid collections. Radiology 151:337–341

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Shawn D. St. Peter.

Rights and permissions

Reprints 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).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Appendicitis
  • Abscess
  • Drainage
  • Pediatric