Appendicular abscess

Last revised by Andrew Murphy on 18 Mar 2024

Appendicular abscess is considered the most common complication of acute appendicitis, in particular 5th to 10th day after a perforated appendix 1

In 70% of the cases, abdominal pain can be localized to periumbilical region, while 15% have generalized abdominal pain and approximately 8% have epigastric pain 1. Approximately 95% of patients have nausea, vomiting, decreased appetite, and altered bowel habit 1.

Appendicular abscesses can arise either in the peritoneal cavity or the retroperitoneal space.

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

  • the appendix may be visualized within the mass

Shows a fluid collection in the appendicular region with or without internal gas. An appendicolith may often be visualized.

Previously it was believed that early surgical intervention increased mortality in patients with appendicular abscess and hence the well known Ochsner Sherren regimen was followed. With better antibiotics and surgical/anesthetic expertise, early diagnostic laparoscopy followed by drainage of the abscess is now preferred. If the abscess is large (>4 cm), imaging-guided percutaneous drainage followed by delayed appendectomy is considered the preferred treatment 4

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