Retroperitoneal abscess resulting from perforated acute appendicitis

Analysis of its management and outcome

Chi Hsun Hsieh, Yu Chun Wang, Horng Ren Yang, Ping Kuei Chung, Long Bin Jeng, Ray Jade Chen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background. Acute appendicitis may become life threatening if it is complicated by retroperitoneal abscess. To the best of our knowledge, only case reports have been documented; thus, we analyzed the published experiences and reviewed this issue. Materials and Methods. In addition to two patients treated at our institution, a PubMed search identified 22 cases of acute appendicitis, complicated by retroperitoneal abscess, reported by 18 authors between 1955 and 2005. The patients' characteristics, onset of symptoms, timing and methods of diagnosis and management, and outcome are reviewed and analyzed. Results. Most of the patients were adults (21/24, 87.5%), of whom seven were older than 65 years. None of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and less than half (9/24) reported abdominal pain. The average interval between the onset of symptoms and diagnosis was 16 days, and the most effective diagnostic tool was computed tomography. Pathogens were usually polymicrobial, and appendectomy followed by adequate drainage of the abscess was the best treatment. The mortality rate was 16.7% (4/24), and all deaths were caused by profound sepsis. According to the available data, the average hospital stay was 27.3 days for the survivors. Conclusion. The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.

Original languageEnglish
Pages (from-to)762-767
Number of pages6
JournalSurgery Today
Volume37
Issue number9
DOIs
Publication statusPublished - Sep 2007
Externally publishedYes

Fingerprint

Appendicitis
Abscess
Psoas Muscles
Appendectomy
Mortality
Abdominal Wall
Thigh
PubMed
Abdominal Pain
Survivors
Drainage
Length of Stay
Sepsis
Tomography
Therapeutics

Keywords

  • Acute appendicitis
  • Psoas abscess
  • Retroperitoneal abscess

ASJC Scopus subject areas

  • Surgery

Cite this

Retroperitoneal abscess resulting from perforated acute appendicitis : Analysis of its management and outcome. / Hsieh, Chi Hsun; Wang, Yu Chun; Yang, Horng Ren; Chung, Ping Kuei; Jeng, Long Bin; Chen, Ray Jade.

In: Surgery Today, Vol. 37, No. 9, 09.2007, p. 762-767.

Research output: Contribution to journalArticle

Hsieh, Chi Hsun ; Wang, Yu Chun ; Yang, Horng Ren ; Chung, Ping Kuei ; Jeng, Long Bin ; Chen, Ray Jade. / Retroperitoneal abscess resulting from perforated acute appendicitis : Analysis of its management and outcome. In: Surgery Today. 2007 ; Vol. 37, No. 9. pp. 762-767.
@article{fef426cedc084714b8e4090aa553bfbd,
title = "Retroperitoneal abscess resulting from perforated acute appendicitis: Analysis of its management and outcome",
abstract = "Background. Acute appendicitis may become life threatening if it is complicated by retroperitoneal abscess. To the best of our knowledge, only case reports have been documented; thus, we analyzed the published experiences and reviewed this issue. Materials and Methods. In addition to two patients treated at our institution, a PubMed search identified 22 cases of acute appendicitis, complicated by retroperitoneal abscess, reported by 18 authors between 1955 and 2005. The patients' characteristics, onset of symptoms, timing and methods of diagnosis and management, and outcome are reviewed and analyzed. Results. Most of the patients were adults (21/24, 87.5{\%}), of whom seven were older than 65 years. None of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and less than half (9/24) reported abdominal pain. The average interval between the onset of symptoms and diagnosis was 16 days, and the most effective diagnostic tool was computed tomography. Pathogens were usually polymicrobial, and appendectomy followed by adequate drainage of the abscess was the best treatment. The mortality rate was 16.7{\%} (4/24), and all deaths were caused by profound sepsis. According to the available data, the average hospital stay was 27.3 days for the survivors. Conclusion. The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.",
keywords = "Acute appendicitis, Psoas abscess, Retroperitoneal abscess",
author = "Hsieh, {Chi Hsun} and Wang, {Yu Chun} and Yang, {Horng Ren} and Chung, {Ping Kuei} and Jeng, {Long Bin} and Chen, {Ray Jade}",
year = "2007",
month = "9",
doi = "10.1007/s00595-006-3481-5",
language = "English",
volume = "37",
pages = "762--767",
journal = "Surgery Today",
issn = "0941-1291",
publisher = "Springer Japan",
number = "9",

}

TY - JOUR

T1 - Retroperitoneal abscess resulting from perforated acute appendicitis

T2 - Analysis of its management and outcome

AU - Hsieh, Chi Hsun

AU - Wang, Yu Chun

AU - Yang, Horng Ren

AU - Chung, Ping Kuei

AU - Jeng, Long Bin

AU - Chen, Ray Jade

PY - 2007/9

Y1 - 2007/9

N2 - Background. Acute appendicitis may become life threatening if it is complicated by retroperitoneal abscess. To the best of our knowledge, only case reports have been documented; thus, we analyzed the published experiences and reviewed this issue. Materials and Methods. In addition to two patients treated at our institution, a PubMed search identified 22 cases of acute appendicitis, complicated by retroperitoneal abscess, reported by 18 authors between 1955 and 2005. The patients' characteristics, onset of symptoms, timing and methods of diagnosis and management, and outcome are reviewed and analyzed. Results. Most of the patients were adults (21/24, 87.5%), of whom seven were older than 65 years. None of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and less than half (9/24) reported abdominal pain. The average interval between the onset of symptoms and diagnosis was 16 days, and the most effective diagnostic tool was computed tomography. Pathogens were usually polymicrobial, and appendectomy followed by adequate drainage of the abscess was the best treatment. The mortality rate was 16.7% (4/24), and all deaths were caused by profound sepsis. According to the available data, the average hospital stay was 27.3 days for the survivors. Conclusion. The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.

AB - Background. Acute appendicitis may become life threatening if it is complicated by retroperitoneal abscess. To the best of our knowledge, only case reports have been documented; thus, we analyzed the published experiences and reviewed this issue. Materials and Methods. In addition to two patients treated at our institution, a PubMed search identified 22 cases of acute appendicitis, complicated by retroperitoneal abscess, reported by 18 authors between 1955 and 2005. The patients' characteristics, onset of symptoms, timing and methods of diagnosis and management, and outcome are reviewed and analyzed. Results. Most of the patients were adults (21/24, 87.5%), of whom seven were older than 65 years. None of the patients presented with the classical symptoms of acute appendicitis at the onset of the disease, and less than half (9/24) reported abdominal pain. The average interval between the onset of symptoms and diagnosis was 16 days, and the most effective diagnostic tool was computed tomography. Pathogens were usually polymicrobial, and appendectomy followed by adequate drainage of the abscess was the best treatment. The mortality rate was 16.7% (4/24), and all deaths were caused by profound sepsis. According to the available data, the average hospital stay was 27.3 days for the survivors. Conclusion. The formation of complicated retroperitoneal abscesses involving thigh, psoas muscle, perinephric space, or even the lateral abdominal wall is a serious complication of perforated acute appendicitis. An intra-abdominal pathological abnormality cannot be excluded in a patient presenting without abdominal symptoms. The mortality rate can only be reduced by a high index of suspicion, accurate diagnosis, and appropriate treatment.

KW - Acute appendicitis

KW - Psoas abscess

KW - Retroperitoneal abscess

UR - http://www.scopus.com/inward/record.url?scp=34548155992&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548155992&partnerID=8YFLogxK

U2 - 10.1007/s00595-006-3481-5

DO - 10.1007/s00595-006-3481-5

M3 - Article

VL - 37

SP - 762

EP - 767

JO - Surgery Today

JF - Surgery Today

SN - 0941-1291

IS - 9

ER -