title: Intervention not always necessary in post-appendectomy abscesses in children; clinical experience in a tertiary surgical centre and an overview of the literature.
abstract: This study aims to provide an overview of both our own experience and the available literature on the treatment of post-appendectomy abscess (PAA) in children. We performed a historical cohort study encompassing all children aged 0-17 years old treated for a radiologically confirmed PAA between 2007 and 2013. Their medical charts were reviewed and descriptive analyses were performed. A literature search on the treatment of PAA in children was performed. In our cohort, 25 out of 372 (7 %) children developed a PAA. Thirteen were treated with a noninvasive strategy and 12 with an invasive strategy (percutaneous or surgical drainage). The immediate success rate was 9/13 (69 %) and 8/12 (67 %) for the noninvasive and invasive strategy, respectively. In both groups, four children (31 and 33 % resp.) required delayed interventions after their initial treatment. In the literature review, six studies were included which reported a median (range) frequency of persistent or recurrent abscess of 9 % (0-30 %), 50 % (0-100 %) and 24 % (0-33 %) for the antibiotic (noninvasive), percutaneous drainage (invasive) and surgical drainage strategies, respectively.
  
  
  CONCLUSIONS
  Although confounding by indication cannot be excluded, we recommend noninvasive treatment as a safe strategy for PAA in children with stable condition.
  
  
  BACKGROUND
  • Post-appendectomy abscess is a well-known and feared complication, occurring in up to 24 % of the children treated surgically for appendicitis. • Several strategies are available to treat this condition, all with advantages and disadvantages. What is new: • Noninvasive strategy is a safe strategy for children with a PAA in a stable condition. • An overview of the literature (the first to our knowledge) supports the above-mentioned statement.
authors: Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, P. O. Box 22660, 1100 DD, Amsterdam, The Netherlands. rr.gorter@vumc.nl.|Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands. rr.gorter@vumc.nl.
authors: Ramon R
authors: RR
authors: Gorter
authors: Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, P. O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors: Suzanne
authors: S
authors: Meiring
authors: Division Woman and Child, Academic Medical Centre, Amsterdam, the Netherlands.
authors: Johanna H
authors: JH
authors: van der Lee
authors: Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, P. O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors: Hugo A
authors: HA
authors: Heij
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appendicitis; Drainage procedure; Intra-abdominal abscess; Post-appendectomy abscess