RECURRENT APPENDICITIS AFTER INITIAL CONSERVATIVE MANAGEMENT OF APPENDICEAL ABSCESS

Therapy for children with appendiceal abscess remains controversial. T he authors present two such cases initially treated conservatively, wi thout interval appendectomy, that later had recurrent appendicitis. An 8-year-old boy presented with fever, abdominal pain, and a right-lowe r-quadrant abscess (noted by ultrasonography). During laparotomy, the abscess was drained and the appendix was not found. He was lost to fol low-up but returned 2 1/2 years later with perforated appendicitis. An appendectomy was performed, and image-guided drainage of a postoperat ive abscess was required. A 10-year-old girl presented with fever and right-lower-quadrant pain. Computed tomography showed a multiloculated mass. During laparotomy, the cecum was found to be densely adherent t o the pelvic organs and bowel, so the surrounding abscess was drained. Interval appendectomy was refused. The patient returned 8 months late r with recurrent acute appendicitis and an appendiceal abscess requiri ng appendectomy and drainage. Although initial drainage alone of appen diceal abscess is efficacious, the authors strongly advocate interval appendectomy as a critical component of the complete management of thi s entity. Copyright (C) 1996 by W.B. Saunders Company