Clinical scenario

This protocol addresses the management of a confirmed appendicular abscess in a patient who is clinically stable with no haemodynamic instability. Stability in this context allows for a measured, stepwise approach rather than emergency operative intervention.

Patient profile

The patient presents with an appendicular abscess and is haemodynamically stable. The treatment approach in stable patients differs fundamentally from that in unstable patients, where immediate surgery is required. Here, a conservative pathway is the primary consideration.

Management approach (partial overview)

In stable patients, a conservative strategy involving intravenous antibiotics and image-guided drainage is the foundation of care, with a laparoscopic surgical alternative available where appropriate expertise exists.

The complete treatment sequence, drainage criteria, and surgical decision pathway are available in the full protocol below.

References

DOI: 10.36346/sarjs.2024.v05i06.001

The treatment of an appendicular abscess can be divided into conservative treatment with intravenous antibiotics and percutaneous drainage of the abscess in stable patients.
Conservative treatment of an appendicular abscess involves starting the patient on intravenous antibiotics, analgesics, monitoring the vital signs and keeping the patient fasted.
The World Society of Emergency Surgeons (WSES) in their guidelines for the management and treatment of acute appendicitis have recommended that patients with an appendicular mass or abscess can be managed with an immediate laparoscopic appendectomy and conservative treatment with intra-venous antibiotics and percutaneous drainage of abscess may be employed when laparoscopic surgical services are not available.
If expertise for laparoscopic surgery is available, then an immediate appendectomy should be performed as this will eliminate the problem and reduce the risk of recurrence.

View source ↗

Treatment of Appendicular Abscess in the Clinically Stable Patient

References