Appendicular abscess surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Appendicular abscess}} | {{Appendicular abscess}} | ||
{{CMG}};{{AE}}{{ADG}} | {{CMG}}; {{AE}}{{ADG}} | ||
==Overview== | ==Overview== | ||
Following drain and antibiotics an [[Appendectomy|interval appendectomy]] is recommended for patients after six to eight weeks. The surgical approach can be either laparoscopic or open (laparotomic). | Following drain and antibiotics, an [[Appendectomy|interval appendectomy]] is recommended for patients after six to eight weeks. The surgical approach can be either laparoscopic or open (laparotomic). | ||
==Surgery== | ==Surgery== | ||
===Percutaneous drainage=== | ===Percutaneous drainage=== | ||
*Percutaneous drainage can be performed under ultrasound or CT guidance, using either the Seldinger or trocar technique.<ref name="pmid14767853">{{cite journal |vauthors=Hogan MJ |title=Appendiceal abscess drainage |journal=Tech Vasc Interv Radiol |volume=6 |issue=4 |pages=205–14 |year=2003 |pmid=14767853 |doi= |url=}}</ref> | *Percutaneous drainage can be performed under ultrasound or CT guidance, using either the [[Seldinger technique|Seldinger]] or [[trocar]] technique.<ref name="pmid14767853">{{cite journal |vauthors=Hogan MJ |title=Appendiceal abscess drainage |journal=Tech Vasc Interv Radiol |volume=6 |issue=4 |pages=205–14 |year=2003 |pmid=14767853 |doi= |url=}}</ref> | ||
*Ultrasound is limited if the [[abscess]] is small, obscured by other structures, or if precise placement is required because of nearby [[vessels]] or [[organs]]. In these cases, CT is the optimal imaging modality.<ref name="pmid11232683">{{cite journal |vauthors=Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G |title=Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=409–16 |year=2001 |pmid=11232683 |doi=10.1111/j.1572-0241.2001.03551.x |url=}}</ref> | *Ultrasound is limited if the [[abscess]] is small, obscured by other structures, or if precise placement is required because of nearby [[vessels]] or [[organs]]. In these cases, CT is the optimal imaging modality.<ref name="pmid11232683">{{cite journal |vauthors=Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G |title=Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=409–16 |year=2001 |pmid=11232683 |doi=10.1111/j.1572-0241.2001.03551.x |url=}}</ref> | ||
*When an [[abscess]] is deep in the [[pelvis]], depending on the specific location of the [[fluid]] collection, access may be obtained via transgluteal, transvaginal, or transrectal approaches.<ref name="urlRetroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess">{{cite web |url=http://dx.doi.org/10.1155/2015/707191 |title=Retroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess |format= |work= |accessdate=}}</ref> | *When an [[abscess]] is deep in the [[pelvis]], depending on the specific location of the [[fluid]] collection, access may be obtained via transgluteal, transvaginal, or transrectal approaches.<ref name="urlRetroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess">{{cite web |url=http://dx.doi.org/10.1155/2015/707191 |title=Retroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess |format= |work= |accessdate=}}</ref> | ||
*If the [[fluid]] collection is [[sterile]], a transgluteal approach is preferred because it allows for sterile technique.<ref name="pmid11232683">{{cite journal |vauthors=Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G |title=Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=409–16 |year=2001 |pmid=11232683 |doi=10.1111/j.1572-0241.2001.03551.x |url=}}</ref> | *If the [[fluid]] collection is [[sterile]], a transgluteal approach is preferred because it allows for sterile technique.<ref name="pmid11232683">{{cite journal |vauthors=Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G |title=Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience |journal=Am. J. Gastroenterol. |volume=96 |issue=2 |pages=409–16 |year=2001 |pmid=11232683 |doi=10.1111/j.1572-0241.2001.03551.x |url=}}</ref> | ||
*Depending on the location of abscess, patient is placed in prone or supine position on the CT table | *Depending on the location of abscess, patient is placed in prone or supine position on the CT table. | ||
*Localization scan using CT allows in selecting a safe window of access into the collection. | *Localization scan using CT allows in selecting a safe window of access into the collection. | ||
*A coaxial micropuncture introducer set is advanced into the abscess under CT guidance. | *A coaxial micropuncture introducer set is advanced into the abscess under CT guidance. | ||
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Indications: | Indications: | ||
*When patients present with life-threatening signs of [[peritonitis]] | *When patients present with life-threatening signs of [[peritonitis]] | ||
* | *Large appendiceal abscess | ||
*In patients with an extraluminal [[appendicolith]] | *In patients with an extraluminal [[appendicolith]] | ||
===Interval Appendectomy=== | ===Interval Appendectomy=== | ||
Following drain and antibiotics an [[Appendectomy|interval appendectomy]] is recommended for patients after six to eight weeks | Following drain and antibiotics, an [[Appendectomy|interval appendectomy]] is recommended for patients after six to eight weeks. It may be performed to: | ||
*Prevent recurrence of [[Appendicitis|appendicitis.]]<ref name="pmid21540609">{{cite journal |vauthors=Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD |title=Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials |journal=Dig Surg |volume=28 |issue=3 |pages=210–21 |year=2011 |pmid=21540609 |doi=10.1159/000324595 |url=}}</ref> | *Prevent recurrence of [[Appendicitis|appendicitis.]]<ref name="pmid21540609">{{cite journal |vauthors=Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD |title=Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials |journal=Dig Surg |volume=28 |issue=3 |pages=210–21 |year=2011 |pmid=21540609 |doi=10.1159/000324595 |url=}}</ref> | ||
*Exclude [[neoplasms]] as a cause (such as [[Carcinoid|carcinoid,]] [[adenocarcinoma]], [[mucinous cystadenoma]], and [[Cystadenocarcinoma|cystadenocarcinomas]]) | *Exclude [[neoplasms]] as a cause (such as [[Carcinoid|carcinoid,]] [[adenocarcinoma]], [[mucinous cystadenoma]], and [[Cystadenocarcinoma|cystadenocarcinomas]]) | ||
Complications of interval appendectomy | Complications of interval appendectomy may include: | ||
*[[Infection|Wound Infection]] ([[sepsis]]) | *[[Infection|Wound Infection]] ([[sepsis]]) | ||
*[[Pelvic abscess]] | *[[Pelvic abscess]] | ||
*[[Aspiration pneumonia]] | *[[Aspiration pneumonia]] | ||
Late | Late complications can include: | ||
*[[Adhesions|Abdominal adhesions]] | *[[Adhesions|Abdominal adhesions]] | ||
*Fecal fistula<ref name="pmid22451186">{{cite journal |vauthors=Singal R, Gupta S, Mittal A, Gupta S, Singh M, Dalal AK, Goyal S, Singh B |title=Appendico-cutaneous fistula presenting as a large wound: a rare phenomenon-brief review |journal=Acta Med Indones |volume=44 |issue=1 |pages=53–6 |year=2012 |pmid=22451186 |doi= |url=}}</ref> | *Fecal fistula<ref name="pmid22451186">{{cite journal |vauthors=Singal R, Gupta S, Mittal A, Gupta S, Singh M, Dalal AK, Goyal S, Singh B |title=Appendico-cutaneous fistula presenting as a large wound: a rare phenomenon-brief review |journal=Acta Med Indones |volume=44 |issue=1 |pages=53–6 |year=2012 |pmid=22451186 |doi= |url=}}</ref> | ||
The following video demonstrates visualization of appendicular abscess: | |||
{{#ev:youtube|SRMOktFZim0}} | {{#ev:youtube|SRMOktFZim0}} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:45, 2 May 2017
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Appendicular abscess Microchapters |
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Appendicular abscess surgery On the Web |
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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
Following drain and antibiotics, an interval appendectomy is recommended for patients after six to eight weeks. The surgical approach can be either laparoscopic or open (laparotomic).
Surgery
Percutaneous drainage
- Percutaneous drainage can be performed under ultrasound or CT guidance, using either the Seldinger or trocar technique.[1]
- Ultrasound is limited if the abscess is small, obscured by other structures, or if precise placement is required because of nearby vessels or organs. In these cases, CT is the optimal imaging modality.[2]
- When an abscess is deep in the pelvis, depending on the specific location of the fluid collection, access may be obtained via transgluteal, transvaginal, or transrectal approaches.[3]
- If the fluid collection is sterile, a transgluteal approach is preferred because it allows for sterile technique.[2]
- Depending on the location of abscess, patient is placed in prone or supine position on the CT table.
- Localization scan using CT allows in selecting a safe window of access into the collection.
- A coaxial micropuncture introducer set is advanced into the abscess under CT guidance.
- An Amplatz guidewire is advanced through the sheath and coiled within the abscess.
- After serial dilatation of the tract with a dilator, an pigtail drain is advanced over the guidewire and deployed.
Emergency appendectomy
Indications:
- When patients present with life-threatening signs of peritonitis
- Large appendiceal abscess
- In patients with an extraluminal appendicolith
Interval Appendectomy
Following drain and antibiotics, an interval appendectomy is recommended for patients after six to eight weeks. It may be performed to:
- Prevent recurrence of appendicitis.[4]
- Exclude neoplasms as a cause (such as carcinoid, adenocarcinoma, mucinous cystadenoma, and cystadenocarcinomas)
Complications of interval appendectomy may include:
Late complications can include:
- Abdominal adhesions
- Fecal fistula[5]
The following video demonstrates visualization of appendicular abscess: {{#ev:youtube|SRMOktFZim0}}
References
- ↑ Hogan MJ (2003). "Appendiceal abscess drainage". Tech Vasc Interv Radiol. 6 (4): 205–14. PMID 14767853.
- ↑ 2.0 2.1 Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G (2001). "Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience". Am. J. Gastroenterol. 96 (2): 409–16. doi:10.1111/j.1572-0241.2001.03551.x. PMID 11232683.
- ↑ "Retroperitoneal Perforation of the Appendix Presenting as a Right Thigh Abscess".
- ↑ Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD (2011). "Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials". Dig Surg. 28 (3): 210–21. doi:10.1159/000324595. PMID 21540609.
- ↑ Singal R, Gupta S, Mittal A, Gupta S, Singh M, Dalal AK, Goyal S, Singh B (2012). "Appendico-cutaneous fistula presenting as a large wound: a rare phenomenon-brief review". Acta Med Indones. 44 (1): 53–6. PMID 22451186.