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Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective
Author(s) -
Collins Geoffrey,
Allaway Matthew G. R.,
Eslick Guy D.,
Cox Michael R.
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.16023
Subject(s) - medicine , percutaneous , drainage , surgery , appendicitis , abscess , ecology , biology
Background Intra‐abdominal abscess (IAA) post‐appendicectomy occurs in 1.4–4.4% of cases. Non‐operative management of small (<4 cm) post‐appendicectomy IAA in children is well established, but minimal evidence exists in adults. Percutaneous catheter drainage is considered standard treatment for IAA, yet outcome data for post‐appendicectomy IAA are sparse. The aims of this study were to assess the effectiveness of non‐operative management of small (<4 cm diameter) IAA and the outcomes of percutaneous drainage for larger (>4 cm) IAA post‐appendicectomy. Methods A retrospective case note review of a series of patients with a post‐appendicectomy IAA between 2006 and 2017 was conducted. IAAs were treated selectively; small (<4 cm) IAAs were managed non‐operatively and larger IAAs were managed with percutaneous drainage . Results A total of 4901 patients had an appendicectomy. Forty‐two (0.9%) developed a post‐operative IAA. Sixteen (38%) had a percutaneous drainage and 26 (62%) had non‐operative management. The percutaneous drainage group had a higher proportion of complicated appendicitis (75%) compared to the non‐operative group (42%, P = 0.04). The percutaneous drainage group had a significantly higher leucocytosis ( P = 0.01) and C‐reactive protein ( P = 0.02). All patients managed non‐operatively resolved without the need for invasive procedures. In the percutaneous drainage group, six had aspiration alone, nine had a percutaneous drain and one was abandoned. Three required repeat percutaneous drainage and four (25%) required operative drainage. Seven patients (34%) of the percutaneous drainage group had grade II or III complications. Conclusion This case series study provides support that small (<4 cm) IAA post‐appendicectomy can be safely and effectively managed non‐operatively.