Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon

Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval ap pendectomy) compared with immediate surgery. Methods: We undertook an observational, retrospective co hort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients youn ger than 14, with severe sepsis or with diffuse peritonitis were ex cluded. A study group of 15 patients with acute appendicitis com plicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and la ter randomized 1:1. The infectious risk stratification was establis hed with the National Nosocomial Infections Surveillance System (NNIS) index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p < 0.05 considered significant. Results: Interval appendectomy was performed in 7 study group patients. Surgical site infection episodes were more fre quent in the control group (6 vs. 0, p < 0.001). A greater percen tage of high risk patients (NNIS ≥ 2) was identified in the control group (80 vs. 28.7%, p < 0.03), mostly related with contaminated or dirty procedures in this group (p < 0.001). No significant diffe rence between groups was found in hospital stay. Conclusion: Initial conservative treatment should be conside red the best therapeutic choice for acute appendicitis with abscess or phlegmon.