title: Is there a role for routine abdominal imaging in predicting postoperative intraabdominal abscess formation after appendectomy for pediatric ruptured appendix?
abstract: To determine if there is a role for routine abdominal imaging in predicting postoperative intraabdominal abscess after appendectomy for the pediatric ruptured appendix. From January 2000 to December 2003 inclusive, 44 consecutive pediatric patients with a ruptured appendix had an open appendectomy and were treated for a minimum of 5 days with triple antibiotics. On postoperative day 5, each patient was evaluated for symptoms (fever, abdominal pain, gastrointestinal dysfunction) and radiological evidence of an intraabdominal fluid collection. Further treatment was determined by the clinical evidence of continuing infection. On postoperative day 5, 36 (82%) of the 44 patients were asymptomatic, had an intraabdominal fluid collection less than 5 cm, diagnosed by ultrasound or computed tomography and received no further treatment. Two of these 36 patients (6%) returned within a week, symptomatic and with a larger collection suspicious for an intraabdominal abscess and requiring further treatment. The other 8 (18%) were symptomatic, and had an intraabdominal abscess more than 5 cm on imaging. All required further treatment, and recovered well. The use of routine abdominal imaging on postoperative day 5, (compared with clinical evaluation), did not improve the ability to predict the development of an intraabdominal abscess.
authors.affiliation: The Division of General Surgery, Rm 1526, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8. a_ein@istar.ca
authors.forename: Sigmund H
authors.initials: SH
authors.lastname: Ein
authors.forename: Paul
authors.initials: P
authors.lastname: Wales
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Langer
authors.forename: Alan
authors.initials: A
authors.lastname: Daneman
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000009:adverse effects*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000601:surgery*; D008297:Male; D011237:Predictive Value of Tests; D011860:Radiography, Abdominal; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents