Query: Abscess Appendiceal

title: Management of appendiceal mass and abscess in children; early appendectomy or initial non operative treatment? A systematic review and meta analysis
abstract: Appendiceal mass and abscess and its treatment are associated with significant morbidity and high costs. Still, the optimal treatment strategy is the point of debate. Therefore, this systematic review and meta analysis aimed to compare overall complications between initial non operative treatment (NOT) and early appendectomy (EA) in children with appendiceal mass and/or abscess. Pubmed and Embase were searched. Only randomized controlled trials and prospective or historical cohort studies that compared NOT with EA in children with appendiceal mass or abscess in terms of complications were eligible for inclusion. Risk of bias was assessed. Primary outcome was the overall complication rate. Secondary, length of stay and readmission rate were investigated. A meta analysis of overall complications associated with both treatment strategies was performed. 14 of 7083 screened studies were selected, including 1022 children in the NOT group and 333 in the EA group. Duration of follow up ranged between four weeks and 12 years. Risk of bias was moderate in four and serious in 10 studies. NOT was associated with a lower overall complication rate (risk ratio (RR) 0.37 [95% confidence interval (CI) 0.21 0.65] However, NOT led to increased length of stay (mean difference varied between 0.2 and 8.4 days) and higher readmission rate (RR 1.75 [95%CI 0.79 3.89] although not significantly. Interval appendectomy after NOT was performed as a routine procedure in all but one study. This study found a recurrence rate of 34% in a group of 38 patients during a follow up period of 3.4 1.7 years. NOT may reduce the overall complication rate compared to EA, but the evidence is very uncertain. As evidence is scarce, and of low level, and heterogeneity between studies is substantial, the results should be interpreted with caution. Large prospective studies are needed to determine the optimal treatment strategy for children with appendiceal mass and/or abscess.

title: A Retrospective Risk Analysis of Factors Associated with Prolonged Hospitalization in Adult Patients Undergoing Non surgical Treatment for Appendiceal Abscess
abstract: The aim of the present study was to investigate risk factors and predictive factors for prolonged hospitalization in adults undergoing non surgical treatment for appendiceal abscess.  A retrospective study was conducted of consecutive patients who underwent treatment following a diagnosis of appendicitis in a single institution. Between January 2008 and May 2019, 756 adult patients who were diagnosed with acute appendicitis, 101 of these patients (13.4% had an appendiceal abscess and were treated as inpatients. The treatments of these patients were as follows: non surgical treatment alone (n=45) emergency operation (n=50) and conversion to emergency operation due to failure of the initial conservative therapy (n=6) The present study analyzed the 45 patients managed with non surgical treatment alone. The patients were divided, based on the median length of the hospital stay (nine day) into the shorter hospital stay and longer hospital stay groups. The risk factors and predictive factors for prolonged hospitalization were examined in the two groups.  Twenty four patients were classified into the shorter hospital stay group and 21 were classified into the longer hospital stay group. A univariate analysis demonstrated that the body temperature on post admission days 2 (P=0.012) and 3 (P=0.008) were significantly associated with the length of hospital stay. A multivariate logistic regression analysis using that the body temperature on post admission day 3 tended to be associated with prolonged hospitalization (odds ratio=8.574, 95% confidence interval=0.973 75.525; P=0.053) The cut off value of the body temperature on day 3, determined by an ROC curve analysis, was 37.05degC. This cut off value showed 66.7% accuracy, 57.1% sensitivity and 75.0% specificity.  The body temperature on post admission day 3 might be a potential risk factor and predictive marker for prolonged hospitalization in patients who receive non surgical treatment for appendiceal abscess.

title: Analysis of difficulties and influencing factors in treatment of appendiceal abscess in children with laparoscopic surgery.
abstract: The purpose of this study was to investigate and analyze the difficulties and influencing factors in the laparoscopic surgery for appendiceal abscess in children. 46 patients with appendiceal abscess receiving laparoscopic surgery (laparoscopic surgery group) in Xuzhou Children's Hospital from January 2012 to March 2017 were retrospectively analyzed. The surgery was performed using the 3 hole method, the 30deg lens was placed in umbilical region, and the left lower abdomen and superior pubis were the operating holes. If the appendix was thick and big, 10 mm Trocar was replaced on the superior pubis and the appendix was removed, followed by pelvic or lower abdominal drainage via the superior pubis incision. The laparoscopic surgery group was compared with 45 cases of laparotomy (traditional surgery group) for appendiceal abscess performed by the same group of operators in the past, and the perioperative period and postoperative complications between the two groups were compared. The child patients' age, history of abdominal pain and pre diagnosis treatment were compared within the laparoscopic surgery group. Compared with those in traditional surgery group, the surgery time in laparoscopic surgery group had no statistically significant difference (p>0.05) the incidence rate of complications was lower, and the difference was statistically significant (p<0.05) In laparoscopic surgery group, the surgery time of child patients aged =6 years old with the medical history for more than 5 days and unreasonable preoperative treatment was longer than that of child patients aged <6 years old with the medical history for less than or equal to 5 days and reasonable preoperative treatment, and the difference was statistically significant (p<0.05) Compared with the traditional surgery, laparoscopic surgery for appendiceal abscess in children can significantly reduce the postoperative complications; at the same time, the history of abdominal pain and preoperative treatment are the influencing factors of surgery.

title: Mucinous Appendiceal Adenocarcinoma Penetrated the Quadratus Lumborum Muscle Posteriorly and Presented as Gluteal Abscess Managed Aggressively with Drainage Followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Combined with Intraoperative Radiotherapy. a Case Report and Re
abstract: Appendiceal mucinous adenocarcinoma is a term that was given for invasive appendiceal tumors. It is always present with pseudomyxoma peritonei which is a complex disease. These tumors have the tendency to surround the primary tumor then extend primarily and extensively all over the peritoneal cavity as the primary site of metastases. The invasion through the abdominal wall muscles is rare but the penetration and passing through these muscles to the subcutaneous tissue are extremely rare. A 62 year old male patient known to have pseudomyxoma peritonei presented with gluteal abscess. After 2 weeks from the abscess drainage, the patient underwent cytoreductive surgery (CRS) combined with intraoperative radiotherapy (IORT) and hyperthermic intraperitoneal chemotherapy (HIPEC) He tolerated the operation well and discharged home in a good condition. Even with extensive appendiceal mucinous neoplasms presented with the penetration of the abdominal wall muscles, still aggressive management should be considered.

title: Laparoscopic treatment of appendiceal abscess in children
abstract: To determine the role of laparoscopic surgery in the treatment of appendiceal abscess in children.  Case reports and a literature review of laparoscopic treatment of appendiceal abscess.  In a two year period, three children were diagnosed with appendiceal abscess presenting as abdominal or fever symptoms, and were treated by laparoscopic surgery. There were two girls and one boy. Mean operative time was 90 minutes (range, 60 120) and there were nopostoperative complications.  Laparoscopy is an effective and safe minimally invasive technique in the management of nocomplicated appendicitis. It is effective even in cases of appendiceal abscess.

title: Misdiagnosis of appendiceal abscess with intestinal malrotation: A case report.
abstract: Here, we report the case of a 75 year old male with abdominal pain who was admitted to our Emergency Department. Computed tomography (CT) scan revealed torsion of the mesenteric root with fluid surrounding the area. Emergency laparotomy, performed under general anesthesia, revealed appendiceal abscess with intestinal malrotation. Appendicectomy was performed after the torsional mesentery restoration. Antibiotics and other symptomatic treatments were administered postoperatively. The patient recovered well and was discharged one week after surgery. Intestinal malrotation is more common in neonates than in adults. The diagnosis of appendicitis could be further obscured by intestinal malrotation. Therefore, the rare situation of intestinal malrotation and ectopic appendicitis in the abdomen should be considered in cases with an absence of right lower abdominal pain, where preoperative abdominal CT shows mesenteric volvulus and the surrounding intestinal wall is thickened and demonstrating exudation.

title: Analysis of Follow Up Results after Successful Conservative Treatment of Pediatric Appendiceal Abscess A Single Institutional Retrospective Study

title: GI VARIANT OF LEMIERRE SYNDROME: COMPLETE OCCLUSION OF SUPERIOR MESENTERIC VEIN IN A 30 YEAR OLD WITH APPENDICEAL ABSCESS

title: Benign Multicystic Peritoneal Mesothelioma Presenting as Appendiceal Abscess: A Diagnostic and Therapeutic Challenge
abstract: Primary peritoneal tumors are rarely encountered and their management is usually challenging for the clinicians. Especially when the patients with advanced peritoneal malignancy present as surgical emergencies, usually with symptoms of obstruction, perforation or gross space occupying lesions, the on call surgical team has to weigh the pros and cons of urgent versus delayed treatment and plans a safe and simultaneously oncologically beneficial therapeutic approach. Herein, we present a case of a Caucasian man who was referred as suspected complicated appendicitis by his primary care physician, with the final diagnosis being benign multicystic mesothelioma. We describe the challenges of the clinical decision making for the emergency general surgeon and relevant diagnostic and therapeutic pitfalls, which can be potentially minimized by early liaison with tertiary units specializing in the treatment of disseminated peritoneal malignancy.

title: Comparison of treatment methods of appendiceal mass and abscess: A prospective Cohort Study
abstract: The aim of our prospective study is to compare and analyze the results of two treatment methods of appendiceal mass and abscess: emergency surgery and conservative treatment with and without interval surgery.  Patients with the diagnosis of appendiceal mass or abscess were enrolled in this study. The patients were assigned into two groups: the emergency surgery group and the conservative management group. The conservative management group was subdivided into two groups: interval surgery group and the ambulatory follow up observation group without interval surgery. Several clinical characteristics were determined and compared between the groups. Among patients who underwent surgery, the surgical methods, operation time, postoperative hospitalization period, and post surgical complications were analyzed. In the ambulatory follow up observation group, recurrence of appendicitis was assessed.  Comparison of the emergency surgery group and interval surgery group revealed that the interval surgery group was characterized by shorter operation time (P 0.008) a smallernumber of postoperative complications (P 0.02) and also shorter postoperative hospital stay (P 0.009) In the ambulatory follow up observation group, recurrence of appendicitis developed in 3 (13% patients. US or CT guided PCD was performed in all 3 patients on the conservative treatment stage. Comparing the interval surgery and recurrent appendicitis groups revealed statistically significant difference: operation time (P 0.04) as well as postoperative hospital stay (P 0.04) were shorter in recurrent appendicitis group. In 3 (4.1% patients, the cause of the appendiceal mass was caecal cancer (2 cases) and Crohn's disease.  Conservative treatment without interval surgery seems to be the preferred method for treatment of appendiceal mass and abscess. Patients can be operated on only in case of recurrence of appendicitis. US or CT PCD of appendiceal abscess presents the risk factor for the development of recurrence of appendicitis. CT and colonoscopy within 4 6 weeks after completing the conservative treatment is recommended to be performed in all patients.