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Does Ruptured Appendicitis with Abscess Warrant Urgent Operative Intervention?

  • Kerrie Lind
Chapter

Abstract

Ruptured appendicitis with abscess formation occurs in up to 10% of patients with appendicitis. When interventional radiology (IR) is available, initial nonsurgical management with percutaneous drainage and IV antibiotics should be attempted, followed by interval appendectomy. Acute operative intervention may increase morbidity and should generally be reserved for patients with large ill-defined abscess, extraluminal appendicolith, and/or life-threatening peritonitis. It should also be considered when IR is unavailable.

Keywords

Ruptured appendicitis Intra-abdominal abscess Appendix Conservative management Operative intervention Surgery Interventional radiology 

References

  1. 1.
    Cheng Y, Xiong X, Lu J, Wu S, Zhou R, Cheng N. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev. 2017;2:6.  https://doi.org/10.1002/14651858.CD011670.pub2.
  2. 2.
    Kim J, Ryoo S, Oh H, Kim J, Shin R, Choe E, Jeong S, Park K. Management of Appendicitis Presenting with abscess or mass. J Korean Soc Coloproctology. 2010;26(6):413–9.  https://doi.org/10.3393/jksc.2010.26.6.413.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Sartelli M. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12:29.  https://doi.org/10.1186/s13017-017-0141-6.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Andersson R, Petzold M. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246(5):741–8.CrossRefGoogle Scholar
  5. 5.
    Amin P, Cheng D. Management of complicated appendicitis in the pediatric population: when surgery doesn’t cut it. Semin Intervent Radiol. 2012;29(3):231–6.  https://doi.org/10.1055/s-0032-1326934.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Craig S. Appendicitis treatment and management. Medscape [Internet] 2017, January 19. Available from: http://emedicine.medscape.com/article/773895-treatment.
  7. 7.
    Marin D, Ho M, Barnhart H, Neville M, White R, Paulson E. Percutaneous abscess drainage in patients with perforated acute appendicitis: effectiveness, safety, and prediction of outcome. AJR Am J Roentgenol. 2010;194(2):422–9.  https://doi.org/10.2214/AJR.09.3098.CrossRefPubMedGoogle Scholar
  8. 8.
    Duggan E, Marshall A, Weaver K, St Peter S, Tice J, Wang L, Choi L, Blakely M. A systematic review and individual patient data meta-analysis of published randomized clinical trials comparing early versus interval appendectomy for children with perforated appendicitis. Pediatr Surg Int. 2016;32(7):649–55.  https://doi.org/10.1007/s00383-016-3897-y.CrossRefPubMedGoogle Scholar
  9. 9.
    Jamieson D. Interventional drainage of appendiceal abscesses in children. AJR Am J Roentgenol. 1997;169(6):1619–22.CrossRefGoogle Scholar
  10. 10.
    Marin D. Percutaneous abscess drainage in patients with perforated acute appendicitis: effectiveness, safety, and prediction of outcome. AJR Am J Roentgenol. 2010;194(2):422–9.CrossRefGoogle Scholar
  11. 11.
    Erdogan D. Comparison of two methods for the management of appendicular mass in children. Pediatr Surg Int. 2005;21(2):81–3.CrossRefGoogle Scholar
  12. 12.
    Salari A. Perforated appendicitis, current concepts in colonic disorders. INTECH. 2012. Available from: http://www.intechopen.com/books/current-concepts-incolonic-disorders/perforated-appendicitis. ISBN: 978-953-307-957-8.
  13. 13.
    Mentula P, Sammalkorpi H, Leppaniemi 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kerrie Lind
    • 1
  1. 1.Medstar Southern Maryland Hospital Center, Department of Emergency MedicineClintonUSA

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