Management of Appendicitis Presenting with Abscess or Mass

Abstract

PurposeManagement strategy in acute appendicitis patients initially presenting with abscess or mass is surrounded with controversy. This study was performed to identify the outcomes of management for this condition.MethodsWe retrospectively analyzed prospectively registered 76 patients (male:female = 39:37; mean age, 50.8 years) with appendicitis presenting with abscess or mass over a 9-year period at the Seoul National University Hospital. Patients were divided into three groups (emergency operation group, delayed operation group, and follow-up group), and clinical characteristics and outcomes of treatment were investigated.ResultsTwenty-eight patients (36.8%) underwent an emergency operation. Of the remaining 48 patients, 20 (41.7%) were initially treated with conservative management through the use of antibiotics only; the other 28 (58.3%) with and additional ultrasound-guided percutaneous drainage of the abscess. Twenty-six (54.2%) patients underwent planned operations after conservative management, and 22 (45.8%) were followed without surgery (median duration, 37.8 month), of which 3 (13%) underwent an appendectomy due to recurrent appendicitis (mean of 56.7 days after initial attack). There were no statistical differences in types of operation performed (appendectomy or ileocecectomy), postoperative complications, and postoperative hospital stay among the patients who underwent emergency operations, delayed operations and operations for recurrence during follow-up.ConclusionAlthough the recurrence rate was relatively low after conservative management for appendicitis patients presenting with abscess or mass, there was no difference in surgical outcome between the emergent, elective, or recurrent groups. Our results indicate that proper management of appendicitis with abscess or mass can be selected according to surgeon's preference.

Retroperitoneal, Abdominal, and Pelvic Abscess in Appendicitis: The Limitation of Diagnostic Modalities

“…Only about 2-7% of patients with appendicitis manifest with complex features such as abscesses; however, if not managed appropriately it can result in potential septic shock [8]. Progression of a retroperitoneal abscess from a perforated appendicitis is unusual and difficult to diagnose as it may lack classical symptoms of acute appendicitis at the onset of the condition and normally may not be associated with peritonitis, thus final diagnosis may only be achieved during surgery [9].…”

Immediate appendectomy for appendiceal mass

“…[4] The common complications after immediate appendectomy are wound infection, intestinal fistula, small bowel obstruction, intra-abdominal abscess, and sepsis. [5,6] The aim of this study was to determine whether immediate appendectomy is a safe alternative to conservative management in patients with appendiceal mass.…”

Anterior Abdominal Wall Abscess in a patient with Acute Suppurative Appendicitis

“…[12] Many patients present with appendicular mass, perforation and abscess because they seek late advice for treatment. [13] The early diagnosis acute appendicitis and its complications by ultrasonography, effective antibiotics and immediate surgical intervention have reduced the complication rate. [14] This may be the reason that only a few cases have been reported with anterior abdominal wall abscess associated with acute appendicitis in last few decades.…”