Appendicular abscess overview
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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
Appendicular abscess is defined as a collection of pus resulting from necrosis of the tissue superimposed with infection in an inflamed appendix. It is unusual and rare entity and a life threatening complication of acute appendicitis. It is seen in 2-7% of population presenting with appendicitis. When the appendix become inflamed (appendicitis), complications arise if it is not treated promptly. When the abscess develops it remains limited by the walls of cavity formed by the inflamed coils of intestine and usually forms in the right lower abdomen. The abscess can spread to pelvis leading peritonitis if the wall is ruptured. In most of the patients the intestinal coils and omentum in the abdominal cavity tend to cover the inflamed appendix forming an appendicular mass. [1]
Historical perspective
Appendicitis was first officially described and coined the term in 1886 by Reginald J. Fitz of Harvard University. Since then, the appendectomy has become one of the most common surgical procedures. The laparoscopic appendectomy was invented in the 1980s, and has led to reduced length of hospital stay, a decreased risk of infection, and a reduction in post-operative pain.
Classification
No known classification of appendicular abscess exists.
Pathophysiology
An appendicular abscess is a complication of acute appendicitis. It is resulted due to the invasion of the appendix by bacteria following an obstruction. The appendix exists at the junction of the small and large intestine and is a natural habitat of wide variety of bacteria. It is therefore prone to develop complications when blocked and coupled with an infection, acute appendicitis can be life threatening and can lead to gangrene, masses, rupture and general peritoneal infections when it gets ruptured. Obstruction of the tubular space inside the appendix is the main inciting event, this initial problem leads to the inflammation of the appendix, obstruction of the blood vessels supplying it, and finally infection. Inflammatory mediators along with various bacterial toxins and proteolytic enzymes from the neutrophils are released, resulting in the formation of abscess in appendix.
Causes
Microbiology responsible for appendicualr abscess includes a mixture of aerobic and anaerobic organisms that are natural habitat of gut. The most commonly isolated aerobic organism is Escherichia coli, and the most commonly observed anaerobic organism is Bacteroides fragilis. The type and density of aerobic and anaerobic bacteria isolated from appendicular abscesses depends upon the organism that dominate the habitat and degree of obstruction.
Differential Diagnosis
Appendicular abscess should be diagnosed early and treat promptly not only to reduce morbidity and mortality, but it is also important to differentiate from other abdominal diseases presenting with RLQ pain , fever, nausea and vomiting such as psoas abscess, cellulitis, torsion of testis and ovaries, ectopic pregnancy etc as the un-drained abscess carries high risk of mortality
Risk factors
Identifying risk factors that predict the likelihood of complications of appendicitis is a crucial step in managing appendicular abscess. Appendicitis is most common risk factor of developing abscess and it is more common among people in the age group of 10 to 30 years old. Appendicitis is one of the medical emergency that need proper attention than any other abdominal causes if symptoms are not conclusive or neglected abscess can develop and can lead to death.
Screening
According to the Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America, there is insufficient evidence to recommend routine screening for appendicular abscess.
References
- ↑ Williams, Norman (2013). Bailey & Love's short practice of surgery. Boca Raton, FLa: CRC Press. ISBN 978-1444121285.