Postoperative Abscess Management After Appendectomy

Acute appendicitis is the most common urgent surgical diagnosis in children, and up to 30% will present with perforated appendicitis. Patients with perforated appendicitis have a longer hospital stay, and up to 25% will develop a postoperative abscess, or infection pocket that many times requires drainage. To minimize potential morbidity in patients who develop a postoperative abscess, an algorithm was established based on previous research from our institution, which found that patients with an abscess size less than 20cm2 who did not receive a drain required fewer CT scans and fewer health care visits.

A prospective, observational study was performed to determine the algorithm's effectiveness in reducing length of stay, antibiotic duration and health care visits. There was an 87% adherence to the algorithm, where patients with abscesses > 20cm2 had the abscess drained along with use of antibiotics, and patients with an abscess < 20cm2 were treated with antibiotics alone. A similar length of stay, duration of antibiotics and number of health care visits were found when comparing groups, indicating that use of antibiotics alone without drain placement is appropriate in patients with a small postoperative intra-abdominal abscess.

Read the publication on intra-abdominal abscess after appendectomy.