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Two-step procedure for complicated appendicitis with perityphlitic abscess formation.
Swiss Med Wkly. 2017; 147:w14422.SM

Abstract

PRINCIPLES

Optimal management of perforated appendicitis with perityphlitic phlegmon or abscess formation is controversial. The aim of the study was to assess the outcome after a two-step procedure to treat patients with perityphlitic abscess formation.

METHODS

We retrospectively assessed prospectively collected data from a single-centre database that included adult patients who had appendicitis and perityphlitic abscess (>=3 cm) but no generalised peritonitis, and were treated in 2007-2015. Patients underwent a two-step procedure that comprised antibiotic treatment and drainage when technically feasible (step 1) followed by interval appendectomy (step 2). We evaluated treatment modalities, complications and outcomes.

RESULTS

Out of a total of 1480 patients with appendicitis, 15 patients presented with perityphlitic abscess. In addition to antibiotic treatment, computed tomography-guided drainage was performed in 12 of these cases. Step 1 and 2 hospital stays were (median, range) 7 days (5–14 days) and 2 days (2–12 days), respectively. One patient’s abscess recurred after 2 months, associated with new onset appendicitis and perforation. Another patient underwent reoperation after interval appendectomy for suspected postoperative peritonitis.

CONCLUSION

This two-step procedure for appendicitis with appendicular abscess was highly successful (100%) with a low rate of complications (13%). In the view of a potentially increased rate of appendicular neoplasm in combination with abscess formation, the role of interval appendectomy has to be evaluated in larger trials.

Authors+Show Affiliations

Department of Surgery, HFR Fribourg - Cantonal Hospital Fribourg, Switzerland.Department of Surgery, HFR Fribourg - Cantonal Hospital Fribourg, Switzerland.Department of Radiology, HFR Fribourg - Cantonal Hospital Fribourg, Switzerland.Department of Surgery, HFR Fribourg - Cantonal Hospital Fribourg, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28421569

Citation

Miftaroski, Almir, et al. "Two-step Procedure for Complicated Appendicitis With Perityphlitic Abscess Formation." Swiss Medical Weekly, vol. 147, 2017, pp. w14422.
Miftaroski A, Kessler U, Monnard E, et al. Two-step procedure for complicated appendicitis with perityphlitic abscess formation. Swiss Med Wkly. 2017;147:w14422.
Miftaroski, A., Kessler, U., Monnard, E., & Egger, B. (2017). Two-step procedure for complicated appendicitis with perityphlitic abscess formation. Swiss Medical Weekly, 147, w14422. https://doi.org/10.4414/smw.2017.14422
Miftaroski A, et al. Two-step Procedure for Complicated Appendicitis With Perityphlitic Abscess Formation. Swiss Med Wkly. 2017;147:w14422. PubMed PMID: 28421569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two-step procedure for complicated appendicitis with perityphlitic abscess formation. AU - Miftaroski,Almir, AU - Kessler,Ulf, AU - Monnard,Etienne, AU - Egger,Bernhard, Y1 - 2017/04/07/ PY - 2017/4/20/entrez PY - 2017/4/20/pubmed PY - 2017/10/4/medline SP - w14422 EP - w14422 JF - Swiss medical weekly JO - Swiss Med Wkly VL - 147 N2 - PRINCIPLES: Optimal management of perforated appendicitis with perityphlitic phlegmon or abscess formation is controversial. The aim of the study was to assess the outcome after a two-step procedure to treat patients with perityphlitic abscess formation. METHODS: We retrospectively assessed prospectively collected data from a single-centre database that included adult patients who had appendicitis and perityphlitic abscess (>=3 cm) but no generalised peritonitis, and were treated in 2007-2015. Patients underwent a two-step procedure that comprised antibiotic treatment and drainage when technically feasible (step 1) followed by interval appendectomy (step 2). We evaluated treatment modalities, complications and outcomes. RESULTS: Out of a total of 1480 patients with appendicitis, 15 patients presented with perityphlitic abscess. In addition to antibiotic treatment, computed tomography-guided drainage was performed in 12 of these cases. Step 1 and 2 hospital stays were (median, range) 7 days (5–14 days) and 2 days (2–12 days), respectively. One patient’s abscess recurred after 2 months, associated with new onset appendicitis and perforation. Another patient underwent reoperation after interval appendectomy for suspected postoperative peritonitis. CONCLUSION: This two-step procedure for appendicitis with appendicular abscess was highly successful (100%) with a low rate of complications (13%). In the view of a potentially increased rate of appendicular neoplasm in combination with abscess formation, the role of interval appendectomy has to be evaluated in larger trials. SN - 1424-3997 UR - https://www.unboundmedicine.com/medline/citation/28421569/Two_step_procedure_for_complicated_appendicitis_with_perityphlitic_abscess_formation_ L2 - http://doi.emh.ch/10.4414/smw.2017.14422 DB - PRIME DP - Unbound Medicine ER -