Abstract
Background
The present study was designed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess.
Methods
In a prospective study, 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were randomly assigned to two groups. The first group received treatment with ultrasound guided-percutaneous drainage and i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group received antibiotics only. Patient’s baseline characteristics, duration of hospital stay, and treatment outcome and complications were analyzed.
Results
Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22–0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment. Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy. There was no statistically significant difference between the two groups regarding patient demographics, abscess size, and pretreatment clinical symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter (p < 0.001) in the drainage group, with a mean difference of 6.4 days (95% CI = 5.0–7.9; p < 0.05).
Conclusions
Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis. The recurrence rate for these patients is relatively low, and very often interval appendectomy is not required. For patients with periappendiceal abscess ≥ 3 cm in diameter, antibiotic therapy alone is insufficient and the recurrence rate is high.
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References
Ball CG, Kortbeek JB, Kirkpatrick AW, Mitchell P (2004) Laparoscopic appendectomy for complicated appendicitis: an evaluation of postoperative factors. Surg Endosc 18:969–973
Bagi P, Dueholm S, Karstrup S (1987) Percutaneous drainage of appendiceal abscess. An alternative to conventional treatment. Dis Colon Rectum 30:532–535
Bagi P, Dueholm S (1987) Nonoperative management of the ultrasonically evaluated appendiceal mass. Surgery 101:602–605
Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215:337–348
Brown CV, Abrishami M, Muller M, Velmahos GC (2003) Appendiceal abscess: immediate operation or percutaneous drainage? Am Surg 69:829–832
Cariati A, Brignole E, Tonelli E, Filippi M, Guasone F, De Negri A, Novello L, Risso C, Noceti A, Giberto M, Giua R (2001) Laparoscopic or open appendectomy. Critical review of the literature and personal experience. G Chir 22:353–357
Cueto J, D’Allemagne B, Vázquez-Frias A, Gomez S, Delgado F, Trullenque L, Fajardo R, Valencia S, Poggi L, Balli J, Diaz J, González R, Mansur JH, Franklin ME (2006) Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc 20:717–720
De U, Ghosh S (2002) Acute appendectomy for appendicular mass: a study of 87 patients. Ceylon Med J 47:117–118
Fishman SJ, Pelosi L, Klavon SL, O’Rourke EJ (2000) Perforated appendicitis: outcome analysis for 150 children. J Pediatr Surg 35:923–926
Gronroos JM, Gronroos P (1999) Leukocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg 86:501–504
Jeffrey RB Jr, Federle MP, Tolentino CS (1988) Periappendiceal inflammatory masses: CT-directed management and clinical outcome in 70 patients. Radiology 167:13–16
Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI (2005) Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis. Arch Surg 140:897–901
Khalili TM, Hiatt JR, Savar A, Lau C, Margulies DR (1999) Perforated appendicitis is not a contraindication to laparoscopy. Am Surg 65:965–967
Klempa I (2002) Current therapy of complicated appendicitis. Chirurg 73:799–804
Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF (2005) Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc 19: 923–926
Krisher SL, Browne A, Dibbins A, Tkacz N, Curci M (2001) Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis. Arch Surg 136:438–441
Lidar Z, Kuriansky J, Rosin D, Shabtai M, Ayalon A (2000) Laparoscopic interval appendectomy for periappendicular abscess. Surg Endosc 14:764–766
Mazziotti MV, Marley EF, Winthrop AL, Fitzgerald PG, Walton M, Langer JC (1997) Histopathologic analysis of interval appendectomy specimens: support for the role of interval appendectomy. J Pediatr Surg 32:806–809
Mohammed AA, Daghman NA, Aboud SM, Oshibi HO (2004) The diagnostic value of C-reactive protein, white blood cell count and neutrophil percentage in childhood appendicitis. Saudi Med J 25:1212–1215
Nguyen DB, Silen W, Hodin RA (1999) Interval appendectomy in the laparoscopic era. J Gastrointest Surg 3:189–193
Oliak D, Yamini D, Udani VM, Lewis RJ, Arnell T, Vargas H, Stamos MJ (2001) Initial nonoperative management for periappendiceal abscess. Dis Colon Rectum 44:936–941
Oliak D, Yamini D, Udani VM, Lewis RJ, Vargas H, Arnell T, Stamos MJ (2000) Nonoperative management of perforated appendicitis without periappendiceal mass. Am J Surg 179:177–181
Rodrigguez-Sanjuan JC, Martin-Parra JI, Seco I, Garcia-Castrillo L, Naranjo A (1999) C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in children. Dis Colon Rectum 42:1325–1329
Sivit CJ, Siegel MJ, Applegate KE, Newman KD (2001) When appendicitis is suspected in children. Radiographics 21:247–262
Stoker ME, Becker JM (1999) Appendicitis. In Clinical Practice of Gastroenterology, edited by LJ Brandt. Philadelphia, Churchill Livingstone, pp. 733–738
Stoltzing H, Thon K (2000) Perforated appendicitis: is laparoscopic operation advisable? Dig Surg 17:610–616
Weber TR, Keller MA, Bower RJ, Spinner G, Vierling K (2003) Is delayed operative treatment worth the trouble with perforated appendicitis in children? Am J Surg 186:685–688
Willemsen PJ, Hoorntje LE, Eddes EH, Ploeg RJ (2002) The need for interval appendectomy after resolution of an appendiceal mass questioned. Dig Surg 19:216–220
Wullstein C, Barkhausen S, Gross E (2001) Results of laparoscopic versus conventional appendectomy in complicated appendicitis. Dis Colon Rectum 44:1700–1705
Yamini D, Vargas H, Bongard F, Klein S, Stamos MJ (1998) Perforated appendicitis: is it truly a surgical urgency? Am Surg 64:970–975
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Zerem, E., Salkic, N., Imamovic, G. et al. Comparison of therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of periappendiceal abscess . Surg Endosc 21, 461–466 (2007). https://doi.org/10.1007/s00464-006-9005-y
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DOI: https://doi.org/10.1007/s00464-006-9005-y