HFR Fribourg Cantonal Hospital Fribourg

Fribourg, Switzerland

HFR Fribourg Cantonal Hospital Fribourg

Fribourg, Switzerland
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Miftaroski A.,HFR Fribourg Cantonal Hospital Fribourg | Kessler U.,HFR Fribourg Cantonal Hospital Fribourg | Monnard E.,HFR Fribourg Cantonal Hospital Fribourg | Egger B.,HFR Fribourg Cantonal Hospital Fribourg
Swiss Medical Weekly | Year: 2017

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 appen-dicular abscess was highly successful (100%) with a low rate of complications (13%). In the view of a potentially increased rate of appendic-ular neoplasm in combination with abscess formation, the role of interval appendectomy has to be evaluated in larger trials.

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