Is there still a benefit to operate appendiceal abscess on board French nuclear submarines?
Appendicular abscess occurred in 14.2% of patients presenting acute appendicitis. Management of these patients remains controversial, ranging from an emergency appendectomy to a nonoperative treatment. On board French nuclear submarines, the usual treatment for all cases of appendiceal masses, including both appendicitis and appendiceal abscess, is an appendectomy. In the past 5 years, the introduction of ultrasonography (US) on board has enabled the diagnosis of appendiceal abscess with a high rate of accuracy, and the latest studies show that nonoperative treatment is an alternative approach. This nonsurgical treatment, based on intravenous administration of antibiotics, is successful in about 93% of the patients. Failure of nonsurgical treatment is a reliable indication of percutaneous drainage. The proportion of adult patients who need percutaneous drainage of abscesses is about 27%. A successful primary nonoperative treatment may or may not be followed by interval appendectomy at the conclusion of the patrol. Nonsurgical treatment is associated with a significantly lower morbidity than surgery. Considering that the on-board surgical facility is limited, nonsurgical treatment appears to be the best approach for treating a sailor with an appendiceal abscess during a submarine patrol mission.
Hornez
Emmanuel
E
Health Service of the Armies, Department of Surgery, Sainte Anne Military Hospital, BP 20545, 83041 Toulon Cedex 09, France.
Gellie
Gabriel
G
Entine
Fabrice
F
Ottomani
Sébastien
S
Monchal
Tristan
T
Meusnier
François
F
Platel
Jean Philippe
JP
de Carbonnieres
Hubert
H
Thouard
Hervé
H
D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D001065:Appendix / Q000601:surgery*; D015780:Carbapenems / Q000627:therapeutic use; D005602:France; D006801:Humans; D008297:Male; D008889:Military Personnel; D010325:Pasteurella; D012421:Rupture / Q000000981:diagnostic imaging / Q000601:surgery; D013366:Submarine Medicine; D014463:Ultrasonography
D000900:Anti-Bacterial Agents; D015780:Carbapenems