British Journal of Surgery 1998, 85, 1111–1113 Abscess after appendicectomy in children: the role of conservative management B. O. OKOYE, B. RAMPERSAD, A. MARANTOS, L. J. ABERNETHY*, P. D. LOSTY and D. A. LLOYD Departments of Paediatric Surgery and *Radiology, Alder Hey Children’s Hospital, University of Liverpool, Liverpool, UK Correspondence to: Mr B. O. Okoye, Department of Paediatric Surgery, Bristol Royal Hospital for Sick Children, St Michael’s Hill, Bristol BS2 8BJ, UK Background Intra-abdominal abscess remains a significant cause of morbidity following appendicectomy. In children, little emphasis has been placed on the non-invasive management of this complication using antibiotic therapy alone. This study reviews the experience of a paediatric surgical department in managing abscess arising after appendicectomy. Methods Hospital records of all children undergoing appendicectomy between January 1992 and January 1997 were reviewed retrospectively. Results Some 1024 children underwent appendicectomy over a 5-year period. Twenty three patients (2·2 per cent) developed abscesses after appendicectomy. Non-operative management with intravenous or oral antibiotics alone was successful in 21 patients, with complete clinical and radiological resolution of the abscess. Drainage of the septic collection was performed in only two patients: by laparotomy ( n = 1) and by the transrectal route ( n = 1). Conclusion Antibiotic therapy alone is an efficacious and safe first-line treatment modality in children who develop this complication. Drainage of an abscess developing after appendicectomy is rarely necessary in children. Acute appendicitis is the commonest emergency requiring abdominal surgery in children 1 . The recommended treatment is appendicectomy, and the management of affected children is standardized in most adult general and paediatric surgical units. Appendicectomy is uni- formly associated with a low morbidity and mortality rate 2 . However, there remains a small yet significant morbidity attributed to complications following surgery. Intra-abdominal abscess is an important cause of pro- longed hospital stay or readmission following appendic- ectomy. The accepted treatment of this complication has followed traditional surgical philosophy which requires drainage of the abscess 1,3 . To this end, there has been a trend towards the use of minimally invasive techniques such as ultrasonographically guided drainage via the percutaneous, transvaginal or transrectal routes, reserving laparotomy for cases in which the intra-abdominal collections are not amenable to evacuation by these methods 3–6 . Although most drainage techniques employ the concomitant use of broad-spectrum antibiotics, little emphasis has been made in the literature regarding solely non-invasive management of abscess after appendic- ectomy with antibiotic therapy alone. In this study, recent experience in the management of this complication in children is presented. Patients and methods The hospital records of all children undergoing appendicectomy between January 1992 and January 1997 were reviewed. Patients who developed an intra-abdominal abscess following appendic- ectomy were entered into the study. Children who had an established appendiceal abscess at initial presentation were excluded from further analysis. Eligible patients were identified and the following information recorded: age, sex, clinical features, white cell count, radiological diagnosis, site and size of abscess, method of definitive treatment and outcome. The fol- lowing details regarding the original appendicectomy were obtained: duration and nature of symptoms before diagnosis, operative findings, cultures of peritoneal swabs, antibiotic therapy and postoperative course. All patients received intraoperative antibiotics, with cefo- taxime and metronidazole administered intravenously. Anti- biotics were administered for varying periods of time after operation depending on the operative findings and clinical course of the patient ( Table 1). If free purulent peritoneal fluid was found at operation, limited lavage was performed with warm normal saline. It is not the authors’ practice to insert peritoneal drains in these patients. All wounds were closed primarily irre- spective of operative findings. Following appendicectomy, an intra-abdominal abscess was suspected if the patient developed increasing abdominal pain, ileus, diarrhoea or persistent pyrexia. After the exclusion of other causes of postoperative pyrexia, such as wound, intra- venous access site, urinary tract or respiratory infection, all patients with the above symptomatology underwent ultra- Paper accepted 20 January 1998 Table 1 Operative findings and antibiotic duration at initial appendicectomy in patients with subsequent abscess Duration of No. of Operative finding antibiotics (h) patients Suppurative appendicitis 24 2 Gangrenous appendicitis (excluding macroscopic perforation) 48 1 Perforated appendicitis 120 20 Total 23 © 1998 Blackwell Science Ltd 1111