Comprehensive Review: Immediate Operation Versus Percutaneous Drainage for Appendicular Abscess – A Prospective Randomized Study
DOI:
https://doi.org/10.69980/ajpr.v26i2.443Abstract
Background: Appendicular abscess is a frequent complication of acute appendicitis, affecting approximately 2–7% of patients, particularly those presenting late. The best therapeutic approach remains a subject of ongoing debate. While emergency surgery offers definitive treatment, it is associated with higher morbidity due to the presence of inflammation and distorted anatomy. Alternatively, ultrasound-guided percutaneous drainage has emerged as a minimally invasive option that may allow resolution of sepsis while avoiding operative risks.
Objective: This study aims to compare the clinical outcomes, complication rates, and hospital stay associated with immediate surgical intervention versus conservative management through ultrasound-guided percutaneous drainage in patients diagnosed with appendicular abscess.
Methods: A prospective randomized controlled trial was conducted between December 2022 and December 2023 at Al Ameen Medical College and Hospital. Forty patients with radiologically confirmed appendicular abscess were enrolled and randomized into two groups: Group 1 (n = 20) underwent emergency appendectomy with intraoperative abscess drainage, and Group 2 (n = 20) received percutaneous drainage using the Seldinger technique under ultrasound guidance. Primary outcomes included duration of hospital stay, time to functional recovery, rate of postoperative complications, and technical and clinical success.
Results: Patients in Group 2 experienced significantly faster recovery (1 ± 0 day) compared to Group 1 (2.2 ± 1 days; p < 0.001). Hospital stay was also shorter in Group 2 (4 ± 1 days) versus Group 1 (7.7 ± 3.5 days; p = 0.02). Complications were substantially higher in Group 1 (40%), including wound infections and burst abdomen, while no complications were reported in Group 2 (p < 0.001). Clinical success was achieved in all patients of Group 2 (100%) compared to 60% in Group 1 (p = 0.007).
Conclusion: Ultrasound-guided percutaneous drainage provides a safer and more effective alternative to emergency surgery for appendicular abscess, with significantly fewer complications and reduced hospitalization. Routine interval appendectomy may be unnecessary and should be reserved for selected recurrent cases.
Keywords: Appendicular abscess, Appendicectomy, Percutaneous drainage, Conservative management, Ultrasound-guided drainage
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7. Appendices
Appendix A: CONSORT Flow Diagram
Flowchart illustrating patient recruitment, inclusion, randomization into two groups, and outcomes.
Appendix B: Surgical and Drainage Techniques (Illustrated)
Illustrations demonstrating McBurney’s incision for emergency appendectomy and the Seldinger technique for pigtail catheter placement.
Appendix C: Long-Term Follow-Up Data
A summary of the 12-month follow-up of Group 2 patients shows:
- 6/20 (30%) underwent interval appendectomy
- 2/14 (14%) experienced recurrence of appendicitis
All recurrences were successfully managed surgically.
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