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Original article

Vol. 147 No. 1314 (2017)

Two-step procedure for complicated appendicitis with perityphlitic abscess formation

DOI
https://doi.org/10.4414/smw.2017.14422
Cite this as:
Swiss Med Wkly. 2017;147:w14422
Published
07.04.2017

Summary

PRINCIPLES

Optimal management of perforated appendicitis with perityphlitic phlegmon or abscess formation is controversial. The aim of the study was to assess the outcome after a two-step procedure to treat patients with perityphlitic abscess formation.

METHODS

We retrospectively assessed prospectively collected data from a single-centre database that included adult patients who had appendicitis and perityphlitic abscess (≥3 cm) but no generalised peritonitis, and were treated in 2007–2015. Patients underwent a two-step procedure that comprised antibiotic treatment and drainage when technically feasible (step 1) followed by interval appendectomy (step 2). We evaluated treatment modalities, complications and outcomes.

RESULTS

Out of a total of 1480 patients with appendicitis, 15 patients presented with perityphlitic abscess. In addition to antibiotic treatment, computed tomography-guided drainage was performed in 12 of these cases. Step 1 and 2 hospital stays were (median, range) 7 days (5–14 days) and 2 days (2–12 days), respectively. One patient’s abscess recurred after 2 months, associated with new onset appendicitis and perforation. Another patient underwent reoperation after interval appendectomy for suspected postoperative peritonitis.

CONCLUSION

This two-step procedure for appendicitis with appendicular abscess was highly successful (100%) with a low rate of complications (13%). In the view of a potentially increased rate of appendicular neoplasm in combination with abscess formation, the role of interval appendectomy has to be evaluated in larger trials.

References

  1. Grundmann RT, Petersen M, Lippert H, Meyer F. Das akute (chirurgische) Abdomen – Epidemiologie, Diagnostik und allgemeine Prinzipien des Managements. [The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management]. Z Gastroenterol. 2010;48(6):696–706.. Article in German.https://doi.org/10.1055/s-0029-1245303
  2. Mason RJ, Moazzez A, Sohn H, Katkhouda N. Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis. Surg Infect (Larchmt). 2012;13(2):74–84. https://doi.org/10.1089/sur.2011.058
  3. Rocha LL, Rossi FM, Pessoa CM, Campos FN, Pires CE, Steinman M. Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: what do meta-analyses say? World J Emerg Surg. 2015;10(1):51. https://doi.org/10.1186/s13017-015-0046-1
  4. Varadhan KK, Humes DJ, Neal KR, Lobo DN. Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis. World J Surg. 2010;34(2):199–209. https://doi.org/10.1007/s00268-009-0343-5
  5. Bradley EL, 3rd, Isaacs J. Appendiceal abscess revisited. Arch Surg. 1978;113(2):130–2. https://doi.org/10.1001/archsurg.1978.01370140020003
  6. Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013;8(1):3. https://doi.org/10.1186/1749-7922-8-3
  7. Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246(5):741–8. https://doi.org/10.1097/SLA.0b013e31811f3f9f
  8. Olsen J, Skovdal J, Qvist N, Bisgaard T. Treatment of appendiceal mass--a qualitative systematic review. Dan Med J. 2014;61(8):A4881.
  9. Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery. 2010;147(6):818–29. https://doi.org/10.1016/j.surg.2009.11.013
  10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  11. Mentula P, Sammalkorpi H, Leppäniemi A. Laparoscopic surgery or conservative treatment for appendiceal abscess in adults? A randomized controlled trial. Ann Surg. 2015;262(2):237–42. https://doi.org/10.1097/SLA.0000000000001200
  12. Ahmed I, Deakin D, Parsons SL. Appendix mass: do we know how to treat it? Ann R Coll Surg Engl. 2005;87(3):191–5. https://doi.org/10.1308/1478708051649
  13. Corfield L. Interval appendicectomy after appendiceal mass or abscess in adults: what is “best practice”? Surg Today. 2007;37(1):1–4. https://doi.org/10.1007/s00595-006-3334-2
  14. Lai HW, Loong CC, Chiu JH, Chau GY, Wu CW, Lui WY. Interval appendectomy after conservative treatment of an appendiceal mass. World J Surg. 2006;30(3):352–7. https://doi.org/10.1007/s00268-005-0128-4
  15. You KS, Kim DH, Yun HY, Jang LC, Choi JW, Song YJ, et al. The value of a laparoscopic interval appendectomy for treatment of a periappendiceal abscess: experience of a single medical center. Surg Laparosc Endosc Percutan Tech. 2012;22(2):127–30. https://doi.org/10.1097/SLE.0b013e318244ea16
  16. Carpenter SG, Chapital AB, Merritt MV, Johnson DJ. Increased risk of neoplasm in appendicitis treated with interval appendectomy: single-institution experience and literature review. Am Surg. 2012;78(3):339–43.
  17. Furman MJ, Cahan M, Cohen P, Lambert LA. Increased risk of mucinous neoplasm of the appendix in adults undergoing interval appendectomy. JAMA Surg. 2013;148(8):703–6. https://doi.org/10.1001/jamasurg.2013.1212
  18. Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH. Is there truly an oncologic indication for interval appendectomy? Am J Surg. 2015;209(3):442–6. https://doi.org/10.1016/j.amjsurg.2014.09.020
  19. Botes SN, Ibirogba SB, McCallum AD, Kahn D. Schistosoma prevalence in appendicitis. World J Surg. 2015;39(5):1080–3. https://doi.org/10.1007/s00268-015-2954-3
  20. Jeffrey RB, Jr, Federle MP, Tolentino CS. Periappendiceal inflammatory masses: CT-directed management and clinical outcome in 70 patients. Radiology. 1988;167(1):13–6. https://doi.org/10.1148/radiology.167.1.3347712
  21. Siewert B, Tye G, Kruskal J, Sosna J, Opelka F, Raptopoulos V, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol. 2006;186(3):680–6. https://doi.org/10.2214/AJR.04.1708
  22. Zerem E, Salkic N, Imamovic G, Terzić I. 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. 2007;21(3):461–6. https://doi.org/10.1007/s00464-006-9005-y
  23. Brown CV, Abrishami M, Muller M, Velmahos GC. Appendiceal abscess: immediate operation or percutaneous drainage? Am Surg. 2003;69(10):829–32.
  24. Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372(21):1996–2005. https://doi.org/10.1056/NEJMoa1411162