MEDICAL-TREATMENT OF POSTAPPENDECTOMY INTRAPERITONEAL ABSCESSES IN CHILDREN

Treatment of postappendectomy intraperitoneal abscesses is classically surgical (drainage). We report a retrospective study (1988 to 1991) o f our experience in providing exclusively medical treatment for 11 suc h isolated. abscesses in children. The abscess was detected 7 times wi thin the 10 days following appendectomy. Ultrasonography localized the abscess 7 times in the right iliac fossa and 4 times in Douglas' pouc h. In 4 cases it was larger than 5cm in diameter. Parenteral antibioti c therapy associated ticarcillin and clavulanic acid 6 times and piper acillin, tobramycin and metronidazole 5 times. Drug efficacy was evalu ated by clinical signs (fever, pain, ileus) and ultrasonography. In on e case, an associated ileus led to reoperation at day 4 of treatment. In the other 10 cases, clinical signs disappeared during the first wee k of treatment. At day 7, parenteral was replaced by oral antibiotic t herapy (metronidazole 7 times, amoxicillin-calavulanic acid 3 times) c ontinued until the abscess was no longer visualized on ultrasonography (5 times at 3 weeks, 5 times at 1 month). Medical treatment of isolat ed postappendectomy abscesses in children would thus appear to be a lo gical choice in the absence of an associated ileus.