Evaluation of Different Treatments for Appendiceal Abscess in Children

Introduction: Despite the high incidence of appendicitis, the diagnosis is often delayed in children. A delayed diagnosis may lead to perforation and formation of an abscess. The treatment of an appendiceal abscess is still a debatable subject and studies have not agreed on what strategy to use. Some prefer immediate operation, whereas others advocate conservative management with or without interval appendectomy. The aim of this study was to evaluate patients treated for appendicular abscess, in order to possibly identify the best treatment algorithm. Method: Medical charts of pediatric patients (<18 years of age) treated for appendiceal abscess between January 2010 and August 2014 were retrospectively studied. The patients were divided into groups based on the type of management; conservative or surgical treatment. Preoperative patient parameters, abscess characteristics, and outcome were evaluated. Results: There was no difference in age, gender, or preoperative data between the surgically and conservatively managed patients. Among the patients diagnosed before the onset of treatment, there was a significantly poorer outcome in the surgically managed group, with a significantly longer duration of hospital stay: 8.5 (range 5-60) days compared to 6 (range 2–10) days (p=0.02), and significantly more complications: 36% compared to 0% (p=0.04). Further, treatment failure seemed to be more common in surgically managed patients with a rate of 25% compared to 0%, however, this was not statistically significant. Conclusion: Conservative management seems to be more beneficial than early surgical intervention in children with appendiceal abscess. Larger