Abcess in perforated appendectomy

Q: In patients who have perforated appendicitis with abscess formation. Which of the following approach is preferred? 

A) Percutaneous abscess drainage 
B) Immediate surgical exploration


Answer: A

In perforated acute appendicitis with abscess formation computed tomography (CT) or ultrasound (US)-guided drainage can be performed either percutaneously or transrectally. This approach seems to result in fewer complications and a shorter length of stay (LOS). Also, it allows inflammation to subside before appendectomy, and fewer chances of extended bowel resection.

#surgical-critical-care


References:

1. Oliak D, Yamini D, Udani VM, et al. Initial nonoperative management for periappendiceal abscess. Dis Colon Rectum 2001; 44:936. 

2. Gee D, Babineau TJ. The optimal management of adult patients presenting with appendiceal abscess: "conservative" vs immediate operative management. Curr Surg 2004; 61:524. 

3. Brown CV, Abrishami M, Muller M, Velmahos GC. Appendiceal abscess: immediate operation or percutaneous drainage? Am Surg 2003; 69:829.