Appendicular abscess medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

No universal standard treatment exists for appendicitis complicated by abscess. The mainstay of treatment includes abscess drainage along with empiric antibiotics. It resolves most of the abscess. Once the abscess is resolved, it is followed by appendectomy 8-12 weeks after the pharmacological treatment.

Treatment

The preferred treatment includes non-operative management such as drainage and broad spectrum IV antibiotics along with IV fluids followed by surgery which includes interval laparoscopic appendectomy. It has proved to have a high success rates up to 97% and low incidences of complications.[1][2][3][4]

Medical Therapy

Antibiotics should be started immediately once the diagnosis of abscess is made. Preoperative antibiotics have been associated with lower rates of wound and intra-abdominal infections.[5][6]

Duration

The duration of treatment with intravenous antibiotics ranges from 5 to 10 days, until fever resolves, white blood cell count normalizes, and bowel function returns.[6]

Empiric therapy

Monotherapy with a beta-lactam/beta-lactamase inhibitor:

Combination third generation cephalosporins PLUS metronidazole

Alternative empiric regimens

Combination fluoroquinolone PLUS metronidazole:

Monotherapy with a carbapenem

References

  1. Samuel M, Hosie G, Holmes K (2002). "Prospective evaluation of nonsurgical versus surgical management of appendiceal mass". J. Pediatr. Surg. 37 (6): 882–6. PMID 12037755.
  2. Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI (2005). "Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis". Arch Surg. 140 (9): 897–901. PMID 16175691.
  3. Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD (2011). "Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials". Dig Surg. 28 (3): 210–21. doi:10.1159/000324595. PMID 21540609.
  4. Meshikhes AW (2008). "Management of appendiceal mass: controversial issues revisited". J. Gastrointest. Surg. 12 (4): 767–75. doi:10.1007/s11605-007-0399-1. PMID 17999120.
  5. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.
  6. 6.0 6.1 Sartelli, Massimo; Viale, Pierluigi; Catena, Fausto; Ansaloni, Luca; Moore, Ernest; Malangoni, Mark; Moore, Frederick A; Velmahos, George; Coimbra, Raul; Ivatury, Rao; Peitzman, Andrew; Koike, Kaoru; Leppaniemi, Ari; Biffl, Walter; Burlew, Clay Cothren; Balogh, Zsolt J; Boffard, Ken; Bendinelli, Cino; Gupta, Sanjay; Kluger, Yoram; Agresta, Ferdinando; Di Saverio, Salomone; Wani, Imtiaz; Escalona, Alex; Ordonez, Carlos; Fraga, Gustavo P; Junior, Gerson Alves Pereira; Bala, Miklosh; Cui, Yunfeng; Marwah, Sanjay; Sakakushev, Boris; Kong, Victor; Naidoo, Noel; Ahmed, Adamu; Abbas, Ashraf; Guercioni, Gianluca; Vettoretto, Nereo; Díaz-Nieto, Rafael; Gerych, Ihor; Tranà, Cristian; Faro, Mario Paulo; Yuan, Kuo-Ching; Kok, Kenneth Yuh Yen; Mefire, Alain Chichom; Lee, Jae Gil; Hong, Suk-Kyung; Ghnnam, Wagih; Siribumrungwong, Boonying; Sato, Norio; Murata, Kiyoshi; Irahara, Takayuki; Coccolini, Federico; Lohse, Helmut A Segovia; Verni, Alfredo; Shoko, Tomohisa (2013). "2013 WSES guidelines for management of intra-abdominal infections". World Journal of Emergency Surgery. 8 (1): 3. doi:10.1186/1749-7922-8-3. ISSN 1749-7922.