Periapendicular abscesses
DOI:
https://doi.org/10.5281/zenodo.14869038Keywords:
periappendiceal abscess, „step- by- step“ approach, secondary peritonitis, „source control“, surgical methodsAbstract
Periappendicular abscesses belong to the group of complicated intra-abdominal infections. They are part of the non-visceral intra-abdominal abscesses and by their nature represent local, limited forms of secondary peritonitis.
According to various studies, 3% to 10% of cases of acute appendicitis are complicated by a periappendicular abscess. The causative organisms are microorganisms of the bowel flora and are often of polymicrobial origin. Overall, the therapeutic algorithm for the treatment of periappendicular abscesses requires a so-called „step- by- step“ approach. After diagnosis, treatment is summarised as two steps: „source control“ and effective antimicrobial therapy. The optimal therapeutic approach is subject to much debate in surgical practice and must be rigorously and individually refined. Operative methods are well established in terms of adequacy and radicality, low incidence of disease recurrence, rehospitalizations, and systemic complications. Disadvantages are expressed in possible complications on the side of the surgical wound and expansion of the volume of surgical intervention. The disadvantages of conservative methods are related to a relatively high rate of disease recurrence within 5 years, missed and delayed diagnosis of underlying malignant and immune-mediated diseases.
References
1. [Bozhkov V., Chernopolski P., Plachkov I., Ivanov T., Madzhov R.; Ostŭr apenditsit pri vŭzrastni patsienti. VI–ta regionalna konferentsiya po khirurgiya na tema: „Ostriyat apenditsit – traen problem v koremnata khirurgiya”. Svilengrad 2017, str 77-8. ] Божков В., Чернополски П., Плачков И., Иванов Т., Маджов Р.; Остър апендицит при възрастни пациенти. VI–та регионална конференция по хирургия на тема: „Острият апендицит – траен проблем в коремната хирургия”. Свиленград 2017, стр 77-8.
2. [Marina M., Korukov B.,Stoyanov St., Damyanov D.. Anaerobni infektsii v koremnata khirurgiya. Sp. Vistseralna khirurgiya; Vol.8, 1-3, 2012; 3-9. ] Марина М., Коруков Б.,Стоянов Ст., Дамянов Д.. Анаеробни инфекции в коремната хирургия. Сп. Висцерална хирургия; Vol.8, 1-3, 2012; 3-9.
3. [Madzhov R., Bozhkov V., Chernopolski P.. Pŭrvichen, vtorichen i tretichen peritonit. Opredelenie, klassifikatsiya, spetsifika na klinichnata kartina i lechenie. Natsionalna konferentsiya po khirurgiya s mezhdunarodno uchastie. Pleven 2019 ISBN 978-954-756-225-7. Sbornik Dokladi str. 50-60.] Маджов Р., Божков В., Чернополски П.. Първичен, вторичен и третичен перитонит. Определение, классификация, специфика на клиничната картина и лечение. Национална конференция по хирургия с международно участие. Плевен 2019 ISBN 978-954-756-225-7. Сборник Доклади стр. 50-60.
4. [Uchikov A., Ivanov YU., Paunov L., Uchikov P., Khadzhiminev V.; Peritoniti ot vŭzpalitelen kharakter; Natsionalna konferentsiya po khirurgiya s mezhdunarodno uchastie. Pleven 2019 ISBN 978-954-756-225-7. Sbornik Dokladi str. 60-66.] Учиков А., Иванов Ю., Паунов Л., Учиков П., Хаджиминев В.; Перитонити от възпалителен характер; Национална конференция по хирургия с международно участие. Плевен 2019 ISBN 978-954-756-225-7. Сборник Доклади стр. 60-66.
5. Bare M, Castells X, Garcia A, et al. Importance of appropriateness of empiric antibiotic therapy on clinical outcomes in intra-abdominal infections. Int J Technol Assess Health Care. 2006 Spring;22(2):242-8.
6. Di Saverio, S., Podda, M., De Simone, B. et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 15, 27 (2020). https://doi.org/10.1186/s13017-020-00306-3 .
7. Deelder JD, Richir MC, Schoorl T, Schreurs WH. How to treat an appendiceal inflammatory mass: operatively or nonoperatively? J Gastrointest Surg. 2014 Apr;18(4):641-5. doi: 10.1007/s11605-014-2460-1. Epub 2014 Feb 4. PMID: 24493295.
8. Delgado-Valverde M, Sojo-Dorado J, Pascual A, et al. Clinical management of infections caused by multi- drug resistant Enterobacteriaceae. Ther Adv Infect Dis. 2013 Apr;1(2):49-69.
9. Demetrashvili Z, Kenchadze G, Pipia I, Khutsishvili K, Loladze D, Ekaladze E, Merabishvili G, Kamkamidze G. Comparison of treatment methods of appendiceal mass and abscess: A prospective Cohort Study. Ann Med Surg (Lond). 2019 Oct 24;48:48-52. doi: 10.1016/j.amsu.2019.10.016. PMID: 31719976; PMCID: PMC6838364.
10. Diarra, A., Keita, K., Traoré, A., Koné, A., Tounkara, I., Traore, I., Thiam, S., Tall, F., Diallo, D., Konate, M., Koné, A., Sanogo, D., Konare, I., Traoré, A. and Togo, A. (2020) Appendicular Abscess in General Surgery at the Bocar Sidi Sall University Hospital in Kati. Surgical Science, 11, 479-485. doi: 10.4236/ss.2020.1112050.
11. K. van Wijck, J. R. de Jong, L. W. E. van Heurn, D. C. van der Zee. Prolonged Antibiotic Treatment does not PreventIntra-Abdominal Abscesses in Perforated Appendicitis; World J Surg (2010) 34:3049–3053; DOI 10.1007/s00268-010-0767-y.
12. Kim JK, Ryoo S, Oh HK, Kim JS, Shin R, Choe EK.Management of appendicitis presenting with abscess or mass.J Korean Soc Coloproctol 2010;26(6):413–419.
13. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Jun;34(6):1589-96.
14. Kreiner L., Lee J., Claridge J., Falagas M., Intra- abdominal abscess; BMJ Best Practice; March 2020; 3-56
15. Mazuski JE, Tessier JM, May AK, Sawyer RG, Nadler EP, Rosengart MR, et al. The Surgical Infection Society Revised Guidelines on the Management of Intra-Abdominal Infection. Surg Infect (Larchmt). 2017 Jan. 18 (1):1-76.
16. Mentula P, Sammalkorpi H, Leppäniemi A. Laparoscopic Surgery or Conservative Treatment for Appendiceal Abscess in Adults? A Randomized Controlled Trial. Ann Surg. 2015 Aug;262(2):237-42. doi: 10.1097/SLA.0000000000001200. PMID: 25775072.
17. Meshikhes AW. Management of appendiceal mass: controversial issues revisited. J Gastrointest Surg. 2008 Apr;12(4):767-75. doi: 10.1007/s11605-007-0399-1. Epub 2007 Nov 13. PMID: 17999120.
18. Mehta NY, Lotfollahzadeh S, Copelin II EL. Abdominal Abscess. [Updated 2022 Dec 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519573/.
19. Rivera AM, Boucher HW. Current concepts in antimicrobial therapy against select gram-positive organisms: methicillin-resistant Staphylococcus aureus, penicillinresistant pneumococci, and vancomycin-resistant enterococci. Mayo Clin Proc. 2011 Dec;86(12):1230-43.
20. Roberts JA, Abdul-Aziz MH, Davis JS, et al. Continuous versus intermittent β-lactam infusion in severe sepsis. A meta-analysis of individual patient data from randomized trials. Am J Respir Crit Care Med. 2016 Sep 15;194(6):681-91.
21. Sartelli, M., Coccolini, F., Kluger, Y. et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg 16, 49 (2021). https://doi.org/10.1186/s13017-021-00387-8.
22. Sartelli, M., Chichom-Mefire, A., Labricciosa, F.M. et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg 12, 29 (2017). https://doi.org/10.1186/s13017-017-0141-6.
23. Saber A. MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF et al. Abdominal Abscess; Updated: Jul 06, 2022;emedicine.medscape; article.
24. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015 May 21;372(21):1996-2005.
25. Solomkin J, Hershberger E, Miller B, et al. Ceftolozane/tazobactam plus metronidazole for complicated intra-abdominal infections in an era of multidrug resistance: results from a randomized, double-blind, phase 3 trial (ASPECT-cIAI). Clin Infect Dis. 2015 May 15;60(10):1462-71.
26. Tannoury J, Abboud B. Treatment options of inflammatoryappendiceal masses in adults.World J Gastroenterol 2013;19(25):3942–3950.
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