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Treatment of Appendiceal Perforation

  • Alex M. Almoudaris
  • Omar Faiz
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

The treatment of appendiceal perforation is subject to considerable debate in current surgical literature. In perforated appendicitis radiologists have an important role both as diagnosticians and in offering interventional treatment options. As a result, knowledge and understanding of the current debate surrounding the treatment of appendiceal perforation is vital for radiologists and surgeons alike. The focus of this chapter is to discuss the treatment of appendiceal perforation with reference to contemporary evidence. General and specific management of the patient with an appendiceal perforation is offered including important pre-operative considerations for both radiologists and surgeons. Timing of surgery, use of laparoscopy and the current debate with respect to interval appendectomy is discussed in an evidence based manner.

Keywords

Foreign Body Carcinoid Tumor Percutaneous Drainage Laparoscopic Appendectomy Perforated Appendicitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Amoli HA, Golozar A et al (2008) Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial. Emerg Med J 25:586–589PubMedCrossRefGoogle Scholar
  2. Andersson RE, Petzold MG (2007) Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg 246:741–748PubMedCrossRefGoogle Scholar
  3. Ball JR (1967) Complete perforation of appendix by a fish bone. Br J Clin Pract 21(2):99PubMedGoogle Scholar
  4. Bingham S, King PA (1999) Sewing-pin perforation of the appendix into the bladder. Pediatr Surg Int 15(1):66–67PubMedCrossRefGoogle Scholar
  5. Bower RJ, Bell MJ et al (1981) Controversial aspects of appendicitis management in children. Arch Surg 116(7):885–887PubMedGoogle Scholar
  6. Brown CV, Abrishami M et al (2003) Appendiceal abscess: Immediate operation or percutaneous drainage? Am Surg 69(10):829–832PubMedGoogle Scholar
  7. Chatwiriyacharoen W (2002) Surgical wound infection post surgery in perforated appendicitis in children. J Med Assoc Thai 85(5):572–576PubMedGoogle Scholar
  8. Chiang RA, Chen SL et al (2006) Comparison of primary wound closure versus open wound management in perforated appendicitis. J Formos Med Assoc 105(10):791–795PubMedCrossRefGoogle Scholar
  9. David IB, Buck JR et al (1982) Rational use of antibiotics for perforated appendicitis in childhood. J Pediatr Surg 17(5):494–500PubMedCrossRefGoogle Scholar
  10. Deakin DE, Ahmed I (2007) Interval appendicectomy after resolution of adult inflammatory appendix mass–is it necessary? Surgeon 5(1):45–50PubMedCrossRefGoogle Scholar
  11. Dellinger RP, Levy MM et al (2008) Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Crit Care Med 36(1):296–327PubMedCrossRefGoogle Scholar
  12. Deschamps L, Couvelard A (2010) Endocrine tumors of the appendix: a pathologic review. Arch Pathol Lab Med 134(6):871–875PubMedGoogle Scholar
  13. Dixon MR, Haukoos JS et al (2003) An assessment of the severity of recurrent appendicitis. Am J Surg 186(6):718–722; discussion 722PubMedCrossRefGoogle Scholar
  14. Faiz O, Blackburn SC et al (2008a) Laparoscopic, conventional appendicectomy in children: outcomes in English hospitals between 1996 and 2006. Pediatr Surg Int 24(11):1223–1227PubMedCrossRefGoogle Scholar
  15. Faiz O, Clark J et al (2008b) Laparoscopic, conventional appendicectomy in children: Outcomes in English hospitals between 1996 and 2006. Ann Surg 248(5):800–806PubMedCrossRefGoogle Scholar
  16. Fornaro R, Frascio M et al (2007) Appendectomy or right hemicolectomy in the treatment of appendiceal carcinoid tumors? Tumori 93(6):587–590PubMedGoogle Scholar
  17. Gallagher EJ, Esses D et al (2006) Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med 48(2): 150–160, 160 e151–154Google Scholar
  18. Gillick J, Mohanan N et al (2008) Laparoscopic appendectomy after conservative management of appendix mass. Pediatr Surg Int 24(3):299–301PubMedCrossRefGoogle Scholar
  19. Goh BK, Chui CH et al (2005) Is early laparoscopic appendectomy feasible in children with acute appendicitis presenting with an appendiceal mass? A prospective study. J Pediatr Surg 40(7):1134–1137PubMedCrossRefGoogle Scholar
  20. Haritopoulos KN, Brown DC et al (2001) Appendiceal mucocoele: a case report and review of the literature. Int Surg 86(4):259–262PubMedGoogle Scholar
  21. Henry MC, Gollin G et al (2007) Matched analysis of nonoperative management versus immediate appendectomy for perforated appendicitis. J Pediatr Surg 42(1):19–23; discussion 23–14PubMedCrossRefGoogle Scholar
  22. Henry MC, Moss RL (2005) Primary versus delayed wound closure in complicated appendicitis: an international systematic review and meta-analysis. Pediatr Surg Int 21(8):625–630PubMedCrossRefGoogle Scholar
  23. Hogan MJ (2003) Appendiceal abscess drainage. Tech Vasc Interv Radiol 6(4):205–214PubMedCrossRefGoogle Scholar
  24. Horwitz JR, Custer MD et al (1997) Should laparoscopic appendectomy be avoided for complicated appendicitis in children? J Pediatr Surg 32(11):1601–1603PubMedCrossRefGoogle Scholar
  25. Kaminski A, Liu IL et al (2005) Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Arch Surg 140(9):897–901PubMedCrossRefGoogle Scholar
  26. Klingler PJ, Seelig MH et al (1998) Ingested foreign bodies within the appendix: a 100 year review of the literature. Dig Dis 16(5):308–314PubMedCrossRefGoogle Scholar
  27. Kogut KA, Blakely ML et al (2001) The association of elevated percent bands on admission with failure and complications of interval appendectomy. J Pediatr Surg 36(1):165–168PubMedCrossRefGoogle Scholar
  28. Krisher SL, Browne A et al (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136(4):438–441PubMedCrossRefGoogle Scholar
  29. Lai HW, Loong CC et al (2006) Interval appendectomy after conservative treatment of an appendiceal mass. World J Surg 30(3):352–357PubMedCrossRefGoogle Scholar
  30. Lee SL, Islam S et al (2010) Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee Systematic Review. J Pediatr Surg 45(11):2181–2185PubMedCrossRefGoogle Scholar
  31. Lemieur TP, Rodriguez JL et al (1999) Wound management in perforated appendicitis. Am Surg 65(5):439–443PubMedGoogle Scholar
  32. Lugo JZ, Avgerinos DV et al (2010) Can interval appendectomy be justified following conservative treatment of perforated acute appendicitis? J Surg Res 164(1):91–94PubMedCrossRefGoogle Scholar
  33. Mazziotti MV, Marley EF et al (1997) Histopathologic analysis of interval appendectomy specimens: Support for the role of interval appendectomy. J Pediatr Surg 32(6):806–809PubMedCrossRefGoogle Scholar
  34. McGory ML, Maggard MA et al (2005) Malignancies of the appendix: Beyond case series reports. Dis Colon Rectum 48(12):2264–2271PubMedCrossRefGoogle Scholar
  35. McGreal GT, Joy A et al (2002) Antiseptic wick: Does it reduce the incidence of wound infection following appendectomy? World J Surg 26(5):631–634PubMedCrossRefGoogle Scholar
  36. Mehrabi Bahar M, Jangjoo A et al (2010) Wound infection incidence in patients with simple and gangrenous or perforated appendicitis. Arch Iran Med 13(1):13–16PubMedGoogle Scholar
  37. Morrow SE, Newman KD (2007) Current management of appendicitis. Semin Pediatr Surg 16(1):34–40PubMedCrossRefGoogle Scholar
  38. Newman K, Ponsky T et al (2003) Appendicitis 2000: variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 38(3):372–379; discussion 372–379PubMedCrossRefGoogle Scholar
  39. Park HC, Yang DH et al (2009) The laparoscopic approach for perforated appendicitis, including cases complicated by abscess formation. J Laparoendosc Adv Surg Tech A 19(6):727–730PubMedCrossRefGoogle Scholar
  40. Pinchot SN, Holen K et al (2008) Carcinoid tumors. Oncologist 13(12):1255–1269PubMedCrossRefGoogle Scholar
  41. Puapong D, Lee SL et al (2007) Routine interval appendectomy in children is not indicated. J Pediatr Surg 42(9):1500–1503PubMedCrossRefGoogle Scholar
  42. Renner K, Holzer B et al (2000) Needle perforation of the appendix. Dig Surg 17(4):413–414PubMedCrossRefGoogle Scholar
  43. Roach JP, Partrick DA et al (2007) Complicated appendicitis in children: a clear role for drainage and delayed appendectomy. Am J Surg 194(6):769–772; discussion 772–763PubMedCrossRefGoogle Scholar
  44. Roberge RJ, Park AJ (2006) Mucocele of the appendix: an important clinical rarity. J Emerg Med 30(3):303–306PubMedCrossRefGoogle Scholar
  45. Roberts JK, Behravesh M et al (2008) Macroscopic findings at appendicectomy are unreliable: Implications for laparoscopy and malignant conditions of the appendix. Int J Surg Pathol 16(4):386–390PubMedCrossRefGoogle Scholar
  46. Samuel M, Hosie G et al (2002) Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. J Pediatr Surg 37(6):882–886PubMedCrossRefGoogle Scholar
  47. Sauerland S, Jaschinski T et al (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 10: CD001546Google Scholar
  48. Simillis C, Symeonides P et al (2010) A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery 147(6):818–829PubMedCrossRefGoogle Scholar
  49. St Peter SD, Valusek PA et al (2007) Does routine nasogastric tube placement after an operation for perforated appendicitis make a difference? J Surg Res 143(1):66–69PubMedCrossRefGoogle Scholar
  50. St Peter SD, Aguayo P 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(1):236–240PubMedCrossRefGoogle Scholar
  51. Styrud J, Eriksson S et al (1998) Treatment of perforated appendicitis: an analysis of 362 patients treated during 8 years. Dig Surg 15(6):683–686PubMedCrossRefGoogle Scholar
  52. Tekin A, Kurtoglu HC et al (2008) Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass. Colorectal Dis 10(5):465–468PubMedCrossRefGoogle Scholar
  53. Tsai HM, Shan YS et al (2006) Clinical analysis of the predictive factors for recurrent appendicitis after initial nonoperative treatment of perforated appendicitis. Am J Surg 192(3):311–316PubMedCrossRefGoogle Scholar
  54. Wallace MJ, Chin KW et al (2010) Quality improvement guidelines for percutaneous drainage/aspiration of abscess and fluid collections. J Vasc Interv Radiol 21(4):431–435PubMedCrossRefGoogle Scholar
  55. Weber TR, Keller MA et al (2003) Is delayed operative treatment worth the trouble with perforated appendicitis is children? Am J Surg 186(6):685–688; discussion 688–689Google Scholar
  56. Willemsen PJ, Hoorntje LE et al (2002) The need for interval appendectomy after resolution of an appendiceal mass questioned. Dig Surg 19(3):216–220; discussion 221Google Scholar
  57. Zerem E, Salkic N et al (2007) Comparison of therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of periappendiceal abscess: is appendectomy always necessary after perforation of appendix? Surg Endosc 21(3):461–466PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Surgery and CancerImperial College, St. Mary’s HospitalLondonUK

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