The role of percutaneous abscess drainage in adult patients with perforated appendicitis

Роль чрескожного дренирования абсцесса у взрослых пациентов с перфоративным аппендицитом
Fatma Kulali 1 * , Aslihan Semiz-Oysu 1, Ozgul Duzgun 2, Yasar Bukte 1
More Detail
1 Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
2 General Surgery Department, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 3, Issue 53, pp. 42-46.
OPEN ACCESS 2787 Views 1866 Downloads
Download Full Text (PDF)


Objectives: To evaluate the effectiveness of ultrasound (US) guided percutaneous abscess drainage in the treatment of adult patients with perforated appendicitis and to estimate the success rate.
Material and methods: Pre-interventional computed tomography examinations of patients (n=63) who had abscess formation due to perforated appendicitis were reviewed retrospectively. A total of 15 patients [6 (40%) women and 9 (60%) men] with a mean age of 42±21 (SD) years who underwent US-guided percutaneous abscess drainage were enrolled in this study. Abscess volume, location, catheter duration and follow-up results were recorded. The treatment effectiveness of US-guided percutaneous abscess drainage was investigated.
Results: A total of 15 patients were included. Abscess formations were in right lower quadrant (n=10) and deep pelvic area (n=5). The mean abscess volume was 235 mm3 (range: 20 - 1180). The mean catheter duration was 12.2 ± 7.8 days (range: 3 - 30). Five patients (5/15, 33%) were treated non-surgically with complete response. In remaining 10 patients (10/15, 67%), surgical management was required because of recurrent abscess (3/15, 20%) and progression in abscess volume (7/15, 47%). The technical success rate and the clinical success rate was 100%, and 33%, respectively.
Conclusion: Because of our low clinical success rate with 33%, we recommended US-guided percutaneous abscess drainage in perforated appendicitis for some selected patients with high risk surgery.


Kulali F, Semiz-Oysu A, Duzgun O, Bukte Y. The role of percutaneous abscess drainage in adult patients with perforated appendicitis. Journal of Clinical Medicine of Kazakhstan. 2019;3(53):42-6.


  • Becker P, Fichtner-Feigl S, Schilling D. Clinical Management of Appendicitis. Visc Med. 2018; 34(6):453-458.
  • Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015; 386(10000):1278-1287.
  • Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005; 185(2):406-17.
  • Liang TJ, Liu SI, Tsai CY, Kang CH, Huang WC, Chang HT, et al. Analysis of recurrence management in patients who underwent nonsurgical treatment for acute appendicitis. Medicine (Baltimore). 2016; 95(12):e3159.
  • Bae SU, Jeong WK, Baek SK. Single-port laparoscopic interval appendectomy for perforated appendicitis with a periappendiceal abscess. Ann Coloproctol. 2016; 32(3):105-10.
  • Tannoury J, Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gastroenterol. 2013; 19(25):3942-50.
  • Augustin T, Cagir B, Vandermeer TJ. Characteristics of perforated appendicitis: effect of delay is confounded by age and gender. J Gastrointest Surg. 2011; 15(7):1223-31.
  • Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery. 2010; 147(6):818-29.
  • Marin D, Ho LM, Barnhart H, Neville AM, White RR, Paulson EK. Percutaneous abscess drainage in patients with perforated acute appendicitis: effectiveness, safety, and prediction of outcome. AJR Am J Roentgenol. 2010; 194(2):422-9.
  • Kim JK, Ryoo S, Oh HK, Kim JS, Shin R, Choe EK, et al. Management of appendicitis presenting with abscess or mass. J Korean Soc Coloproctol. 2010; 26(6):413-9.
  • Aranda-Narváez JM, González-Sánchez AJ, Marín-Camero N, Montiel-Casado C, López Ruiz P, Sánchez-Pérez B, et al. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon. Rev Esp Enferm Dig. 2010; 102(11):648-52.
  • Nimmagadda N, Matsushima K, Piccinini A, Park C, Strumwasser A, Lam L, et al. Complicated appendicitis: Immediate operation or trial of nonoperative management? Am J Surg. 2019; 217(4):713-717.
  • Dong Y, Tan S, Fang Y, Yu W, Li N. Meta-analysis of laparoscopic surgery versus conservative treatment for appendiceal abscess [in Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi. 2018; 21(12):1433-1438.
  • Church JT, Klein EJ, Carr BD, Bruch SW. Early appendectomy reduces costs in children with perforated appendicitis. J Surg Res. 2017; 220:119-124.
  • Cheng Y, Xiong X, Lu J, Wu S, Zhou R, Cheng N. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev. 2017; 6:CD011670.
  • Horn CB, Coleoglou Centeno AA, Guerra JJ, Mazuski JE, Bochicchio GV, Turnbull IR. Drain failure in intra-abdominal abscesses associated with appendicitis. Surg Infect (Larchmt). 2018; 19(3):321-325.
  • Fagenholz PJ, Peev MP, Thabet A, Michailidou M, Chang Y, Mueller PR, et al. Abscess due to perforated appendicitis: factors associated with successful percutaneous drainage. Am J Surg. 2016; 212(4):794-798.
  • St Peter SD, Shah SR, Adibe OO, Sharp SW, Reading B, Cully B, et al. Saline vs tissue plasminogen activator irrigations after drain placement for appendicitis-associated abscess: A prospective randomized trial. J Am Coll Surg. 2015; 221(2):390-6.
  • Sceats LA, Ku S, Coughran A, Barnes B, Grimm E, Muffly M, et al. Operative versus nonoperative management of appendicitis: A long-term cost effectiveness analysis. MDM Policy Pract. 2019; 4(2):2381468319866448.
  • Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015; 313(23):2340-8.
  • Charfi S, Sellami A, Affes A, Yaïch K, Mzali R, Boudawara TS. Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Colorectal Dis. 2014; 29(8):1009-12.