Management of Post Appendicectomy Intra-Abdominal Collections: A Volumetric Cut Off for Drainage?
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In brief
In brief
Retrospective study of 60 pediatric patients with post-appendicectomy intra-abdominal collections found that collection volume significantly predicted failure of medical management. Collections exceeding 2ml/kg body weight were more likely to require procedural intervention, suggesting a volumetric threshold could standardize clinical decision-making for drainage versus conservative treatment.
Written by the GCMD Library team from the article.
Background
Intra-abdominal collections (IAC) are a common complication following appendicectomy, one of the most commonly performed emergency abdominal procedures in childhood. The option to drain a collection is frequently available but not always required.
Aim
The aim of this study was to compare the outcomes of medically and procedurally-managed post appendicectomy IACs and suggest a method of standardising the need for intervention.
Methods
A single centre, retrospective review of children aged ≤16 years presenting between 2014 and 2019 was performed. Patient demographics, management, and outcome data were collected. IAC volume and surface area were calculated assuming a prolate spheroid or true ellipsoid depending on the number of dimensions reported.
Results
60 patients (18%) of patients developed an IAC post appendicectomy. Medical management was undertaken in 44 (73%), drainage in 12 (20%), and surgical washout in 4 (7%). Collection size was associated with failure of medical management: maximum diameter (p=0.028), volume (p=0.002), and surface area (p=0.001). Collections with a volume of 2ml/kg were significantly less likely to fail medical management than larger collections (0/33 vs 6/11; p