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Appendicular abscess

Dr Ayush Goel et al.

Appendicular abscess is considered the most common complication of acute appendicitis.

Radiographic features

Ultrasound

Ultrasound is the first investigation advised to evaluate a suspected appendicular pathology. Findings of an appendicular abscess include:

  • fluid collection (hypoechoic) in the appendicular region which may be well circumscribed and rounded or ill-defined and irregular in appearance
  • appendix may be visualised within the mass
CT

Fluid collection is seen in the appendicular region with or without air within. Many times an appendicolith may be visualized.

Treatment

Previously it was believed that early surgical intervention increases the mortality in patients with appendicular abscess and hence the well known Ochsner Sherren regime was followed. But with better antibiotics and expertise of surgeons and anaesthesiologists, now early diagnostic laproscopy followed by drainage of the abscess is preferred.  If the abscess is large (> 4 cm), percutaneous drainage followed by delayed appendectomy is considered the preferred treatment 4


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