Post-appendectomy intra-abdominal abscesses--can they successfully be managed with the sole use of antibiotic therapy?
OBJECTIVE
Controversy persists concerning the management of post-appendectomy intra-abdominal abscesses. We hypothesised that most of these abscesses can be successfully managed by antibiotic treatment alone, avoiding the complications of surgical treatment.


METHODS
Hospital records of children treated in our unit for intra-abdominal post-appendectomy abscesses over a 6-year period were reviewed retrospectively.


RESULTS
This study investigates a series of 26 children from 2 to 15 years of age presenting with one or more post-appendectomy intra-abdominal abscesses. After an average delay of 7 days after initial surgery, 23 children had developed an isolated abscess, while 3 children had multiple abscesses. Twenty-two patients (84.8 %) were treated conservatively by intravenous triple antibiotic therapy alone. Complete clinical, radiological and biological resolution of the abscesses was obtained in all of these children after a mean hospitalisation of 8 days. Four children (15.2 %) were treated surgically: three children with a stable patient status and one child with septic shock requiring urgent surgery.


CONCLUSIONS
The results suggest that intravenous triple antibiotic therapy alone is an efficacious first-line treatment in children developing intra-abdominal abscesses following appendectomy. Surgical intervention is rarely necessary except in patients with an alarming patient status or with signs of septic shock.
Forgues
D
D
Department of Visceral Paediatric Surgery, University Lapeyronie Hospital, Montpellier Cedex 5, France. d-forgues@chu-montpellier.fr
Habbig
S
S
Diallo
A F
AF
Kalfa
N
N
Lopez
M
M
Allal
H
H
Guibal
M P
MP
Sabatier-Laval
E
E
Galifer
R B
RB
D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy; D002439:Cefotaxime / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D008795:Metronidazole; D002439:Cefotaxime