Appendicular abscess natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Without treatment, the patient with appendicular abscess will likely develop symptoms of diffuse abdominal pain, which is different from typical appendicitis pain, starting centrally (in the periumbilical region) before localizing to the right iliac fossa in the right lower quadrant of the abdomen. During the final stage of the untreated disease process, the appendix will rupture, and this may eventually lead to death if peritonitis develops.[1] Complications that can develop as a result of the untreated appendicular abscess include: septicemia, rupture, peritonitis, hemorrhage and death. Prognosis of the abscess is good with antibiotics and percutaneous drain and resolves without the need for appendectomy,but it is recommended to follow and appendicular abscess by interval appendectomy after 8-12 weeks to prevent recurrence.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of appendicular abscess typically develop when the inflamed appendix gets complicated due to decreased blood flow.
- Without treatment, the patient will likely develop symptoms of diffuse abdominal pain, which is different from typical appendicitis pain, starting centrally (in the periumbilical region) before localizing to the right iliac fossa in the right lower quadrant of the abdomen.
- They will also experience loss of appetite, diarrhea, high grade fever, nausea and vomiting.
- During the final stage of the untreated disease process, the appendix will rupture, and this may eventually lead to death if peritonitis develops.[2]
Complications
Complications that can develop as a result of the untreated appendicular abscess include:
Prognosis
- Majority of the patients with appendicular abscess recover quickly with drain and IV antibiotics, but complications can occur if treatment is delayed or if peritonitis occurs.[3][4]
- It usually takes between 10 and 28 days to recover completely.
- Typical abscess responds quickly to antibiotics and percutaneous drain and resolves spontaneously.
- If abscess resolves, interval appendectomy should be performed 8-12 weeks after to prevent recurrent episodes.
- Atypical presentation (when the patient presents with fever, abdominal pain not typical to appendicitis, diarrhea) is more difficult to diagnose and is more apt to be complicated.
- In such condition prompt diagnosis, and treatment with emergent appendectomy yield the best results with full recovery usually occurring in two to four weeks.
- Mortality of appendicular abscess is very low < 0.2-0.8% but do occur in some cases, especially if peritonitis develops and is left untreated.[5]
References
- ↑ Appendicitis. Wikipedia (2016). http://schools-wikipedia.org/wp/a/Appendicitis.htm Accessed on February 4, 2016
- ↑ Appendicitis. Wikipedia (2016). http://schools-wikipedia.org/wp/a/Appendicitis.htm Accessed on February 4, 2016
- ↑ Pham, Xuan-Binh D.; Sullins, Veronica F.; Kim, Dennis Y.; Range, Blake; Kaji, Amy H.; de Virgilio, Christian M.; Lee, Steven L. (2016). "Factors predictive of complicated appendicitis in children". Journal of Surgical Research. 206 (1): 62–66. doi:10.1016/j.jss.2016.07.023. ISSN 0022-4804.
- ↑ Pattison AC (1936). "FACTORS IN THE MORTALITY OF ACUTE APPENDICITIS". Ann. Surg. 103 (3): 362–74. PMC 1391035. PMID 17856727.
- ↑ Appendicitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Appendicitis#Clinical Accessed on February 4, 2016