title: Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon.
abstract: BACKGROUND
  Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy) compared with immediate surgery.
  
  
  METHODS
  We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS) index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p < 0.05 considered significant.
  
  
  RESULTS
  Interval appendectomy was performed in 7 study group patients. Surgical site infection episodes were more frequent in the control group (6 vs. 0, p < 0.001). A greater percentage of high risk patients (NNIS ≥ 2) was identified in the control group (80 vs. 28.7%, p < 0.03), mostly related with contaminated or dirty procedures in this group (p < 0.001). No significant difference between groups was found in hospital stay.
  
  
  CONCLUSIONS
  Initial conservative treatment should be considered the best therapeutic choice for acute appendicitis with abscess or phlegmon.
authors.affiliation: Servicio de Cirugía General, Digestiva y Trasplante, Hospital Regional Universitario Carlos Haya, Málaga, Spain. josearanda68@telefonica.net
authors.forename: J M
authors.initials: JM
authors.lastname: Aranda-Narváez
authors.forename: A J
authors.initials: AJ
authors.lastname: González-Sánchez
authors.forename: N
authors.initials: N
authors.lastname: Marín-Camero
authors.forename: C
authors.initials: C
authors.lastname: Montiel-Casado
authors.forename: P
authors.initials: P
authors.lastname: López-Ruiz
authors.forename: B
authors.initials: B
authors.lastname: Sánchez-Pérez
authors.forename: A
authors.initials: A
authors.lastname: Alvarez-Alcalde
authors.forename: C P
authors.initials: CP
authors.lastname: Ramírez-Plaza
authors.forename: J
authors.initials: J
authors.lastname: Santoyo-Santoyo
mesh_terms: D000038:Abscess / Q000150:complications* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000628:therapy*; D002481:Cellulitis / Q000150:complications* / Q000628:therapy*; D015331:Cohort Studies; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult