Is an interval appendectomy still necessary in perforated appendicitis with inflammatory mass/abcess

Abstract

We reviewed our experience in non-operative management without an interval appendectomy (IA), for patients who presented with perforated appendicitis with an abcess or inflammatory mass from November 2012 to November 2017 retrospectively. The data included age, sex, duration of symptoms, presence of appendicolith/ abcess on CT imaging, WBC and CRP levels, antibiotic treatment, fever at presentation, percutan drainage procedure and complications, recurrent abscess, total length of hospitalization, follow-up period. A total of 32 patients were treated with nonoperative management during the study period. Nonoperative management without an IA was successful in 31 patients (96%). Study patients included were admitted to the surgical ward for observation. The mean age of the patients was 9.74±3.55 years. 19 male and 13 female patients were included in the study. The mean duration of symptoms was 8.75±4.69 days. The mean number of Ct scans was 1.21±0.42 per patient. Percutan drainage was performed in 10 patients. The mean of WBC levels at presentation was 19030.00±7192.24 cells/μL and CRP levels was 156.61±94.23 mg/dl. Intravenous piperacillin-tazobactam (Tazosin®, Pfizer, New York, NY) were given 400 mg/kg/day in four divided doses. Diet were started to the patients who were afebrile and had diminished abdominal pain during observation. The mean length of hospitalization was 13.03±5.82 days. The mean duration of follow-up period 34.65±20.48 months. Nonoperative management without IA is a preferable choice for perforated appendicitis with abcess or mass.