Can interval appendectomy be justified following conservative treatment of perforated acute appendicitis?
BACKGROUND
There continues to be controversy about the necessity of interval appendectomy for delayed presentation of acute appendicitis. While recent studies suggest that the risk of recurrent disease is small, the risk of interval appendectomy is also small and does provide histologic identification and usually definitive treatment of the right lower quadrant inflammatory process.


METHODS
A retrospective analysis of medical records gathered from 2002 to 2007 at a major teaching hospital of 986 adult patients over the age of 13 with appendicitis were analyzed. Forty-six patients (5%) were found to have right lower quadrant abscess or phlegmon, and were managed with intravenous antibiotics. Some patients also underwent percutaneous drainage. These patients were then readmitted 6 to 26 wk later for an elective laparoscopic interval appendectomy.


RESULTS
There were 19 males and 27 females with an average age of 43 y. Ninety-four percent of the appendectomies were completed laparoscopically; 16% of patients were found to have a normal or obliterated appendix on pathologic evaluation and likely did not benefit from interval appendectomy. On the other hand, 84% of patients had persistent acute appendicitis, chronic appendicitis, evidence of inflammatory bowel disease, or neoplasm identified, and likely benefited from surgical appendectomy.


CONCLUSIONS
Interval appendectomy provides diagnostic and therapeutic benefit to patients who present with a right lower quadrant abdominal inflammatory focus, and should be carefully considered in all adult patients.
Lugo
Joannele Z
JZ
Department of Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA.
Avgerinos
Dimitrios V
DV
Lefkowitz
Amanda J
AJ
Seigerman
Matthew E
ME
Zahir
Ismail S
IS
Lo
Andrew Y
AY
Surick
Burton
B
Leitman
I Michael
IM
D018784:Abdominal Abscess / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy; D001064:Appendicitis / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D002481:Cellulitis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures
D000900:Anti-Bacterial Agents