Treatment of appendiceal abscess

Appendiceal abscess occurring in 193 patients during a 14-year period is reviewed. Treatment was nonsurgical in 98 patients, with a complication rate of 3%. In the 95 surgically treated patients the complication rate was 32%. One patient died. 'Interval' elective appendectomy was performed in 80 cases and the complication rate was 23%. Among the 32 patients without surgery or in whom the appendix was not removed at laparotomy, the recurrence rate was 3%. No malignancy was found at colonic radiography in 84 conservatively treated patients. Based on these findings, the following strategy is recommended for management of appendiceal abscess. 1) Initially conservative treatment, with surgical intervention if this fails. 2) 'Interval' elective appendectomy not routinely undertaken. 3) For patients older than 40, follow-up with colonic radiography, possibly colonoscopy and, if necessary, also exploratory laparotomy to exclude intraabdominal malignancy.