Post-appendectomy intra-abdominal abscesses--can they successfully be managed with the sole use of antibiotic therapy?

Abstract

PURPOSE:

Controversy persists concerning the management of post-appendectomy intra-abdominal abscesses. We hypothesised that most of these abscesses can be successfully managed by antibiotic treatment alone, avoiding the complications of surgical treatment.

METHODS:

Hospital records of children treated in our unit for intra-abdominal post-appendectomy abscesses over a 6-year period were reviewed retrospectively.

RESULTS:

This study investigates a series of 26 children from 2 to 15 years of age presenting with one or more post-appendectomy intra-abdominal abscesses. After an average delay of 7 days after initial surgery, 23 children had developed an isolated abscess, while 3 children had multiple abscesses. Twenty-two patients (84.8 %) were treated conservatively by intravenous triple antibiotic therapy alone. Complete clinical, radiological and biological resolution of the abscesses was obtained in all of these children after a mean hospitalisation of 8 days. Four children (15.2 %) were treated surgically: three children with a stable patient status and one child with septic shock requiring urgent surgery.

CONCLUSION:

The results suggest that intravenous triple antibiotic therapy alone is an efficacious first-line treatment in children developing intra-abdominal abscesses following appendectomy. Surgical intervention is rarely necessary except in patients with an alarming patient status or with signs of septic shock.

• Authors: D Forgues, S Habbig, A F Diallo, N Kalfa, M Lopez, H Allal, M P Guibal, E Sabatier-Laval, R B Galifer
• Journal: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie (Eur J Pediatr Surg) Vol. 17 Issue 2 Pg. 104-9 (Apr 2007) ISSN: 0939-7248 [Print] United States
• PMID: 17503303 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Gentamicins
• Metronidazole
• Cefotaxime

Topics

• Abdominal Abscess (diagnostic imaging, drug therapy, etiology)
• Adolescent
• Anti-Bacterial Agents (administration & dosage)
• Appendectomy
• Cefotaxime (administration & dosage)
• Child
• Child, Preschool
• Clinical Protocols
• Drug Therapy, Combination
• Female
• Gentamicins (administration & dosage)
• Humans
• Male
• Metronidazole (administration & dosage)
• Postoperative Complications (drug therapy)
• Retrospective Studies
• Ultrasonography