Periappendiceal inflammatory masses: CT-directed management and clinical outcome in 70 patients.

Abstract

The outcome was reviewed in 70 patients with computed tomographic (CT) and clinical evidence of periappendiceal inflammatory masses. On the basis of the initial CT scan, patients were divided into three broad categories: (a) patients with periappendiceal phlegmons or abscesses less than 3 cm (n = 32); (b) patients with well-defined and well-localized periappendiceal abscesses greater than 3 cm (n = 28); and (c) patients with extensive, poorly defined periappendiceal abscesses with either pelvic, retroperitoneal, or interloop involvement (n = 10). Thirty-two patients with either phlegmons or small abscesses were treated initially with antibiotic therapy alone; clinical resolution of the inflammatory process occurred in 28 patients (88%). Twenty-eight patients with well-defined and well-localized periappendiceal abscesses underwent percutaneous catheter drainage, which was successful in 26 patients (93%). Nine of ten patients underwent early surgical drainage for extensive, poorly defined abscesses. One patient underwent percutaneous drainage as a temporizing measure before surgery. There were three false-positive CT diagnoses of periappendiceal abscesses in this series.

Appendiceal abscesses: primary percutaneous drainage and selective interval appendicectomy

“…The good primary results of this study are in agreement with previous studies of US-(2, 15, 16) and CT-guided drainage (10,12,15,20,21,25) of appendiceal abscesses. Of the patients studied 10%-15% still needed surgical treatment because of insuf cient drainage or continued production of pus, or increasing clinical symptoms, sometimes with septicaemia or generalised peritonitis, or both.…”

“…Otherwise, primary surgery may necessitate a more extensive operation than appendicectomy, such as an ileocaecal resection, right hemicolectomy, or a temporary ileostomy (17), and these are followed by complication rates of 10%-30% or more (9,13). Non-surgical treatment is safe and effective, with complication rates around 5%-15% (9,12,19,21), particularly when antibiotics are combined with percutaneous drainage (10,12,16). The only problem we encountered was probable displacement of one drain into the gut lumen that yielded gut contents in the drain.…”

“…The risks with immediate surgery, however, include the possible need of more extensive surgery, risk of operative injuries, postoperative (bowel) stula formation, postoperative infection, and ileus (15,20,21,24). Most American authors recommend primary surgical treatment (20,24), while European authors recommend initial conservative non-surgical management using intravenous antibiotics (2,15,19,20) with or without percutaneous drainage (10,20,25).…”

Percutaneous drainage management of an abscess developed from conservatively treated retroperitoneal haematoma caused by acupuncture

“…Most would consider imageguided percutaneous abscess drainage as the treatment of choice because it offers a relatively simple, minimally invasive option with the goal of averting the development of sepsis, reducing the length of the hospital stay and reducing the cost of treatment. Abscesses < 3 cm are often treated with antibiotic therapy alone (Jeffrey et al, 1988). These can be sampled or aspirated with a needle for the assessment of optimal antibiotic coverage.…”

A Comparative Ultrasound and Plain Abdominal X-Ray: Evaluation of Non-Classical Clinical Cases of Appendicitis

“…However, CT is particularly useful in characterizing inflammatory masses around the appendix [21]. The distinction between periappendiceal phlegmon and abscesses is important since the former is often managed conservatively with antibiotics while the latter can be drained percutaneously with CT guidance when it is well defined [8].…”