Management of post appendicectomy intra-abdominal collections: A volumetric cut off for drainage?
J Pediatr Surg
; 57(2): 245-249, 2022 Feb.
Article
en En
| MEDLINE
| ID: mdl-34952694
ABSTRACT
BACKGROUND:
Intra-abdominal collections (IAC) are a common complication following appendicectomy, one of the most commonly performed emergency abdominal procedures in childhood. The option to drain a collection is frequently available but not always required.AIM:
The aim of this study was to compare the outcomes of medically and procedurally-managed post appendicectomy IACs and suggest a method of standardising the need for intervention.METHODS:
A single centre, retrospective review of children aged ≤ 16 years presenting between 2014 and 2019 was performed. Patient demographics, management, and outcome data were collected. IAC volume and surface area were calculated assuming a prolate spheroid or true ellipsoid depending on the number of dimensions reported.RESULTS:
60 patients (18%) of 334 patients developed an IAC post appendicectomy. Medical management was undertaken in 44 (73%), drainage in 12 (20%), and surgical washout in 4 (7%). Collection size was associated with failure of medical management maximum diameter (pâ¯=â¯0.028), volume (pâ¯=â¯0.002), and surface area (pâ¯=â¯0.001). Collections with a volume of 2â¯ml/kg were significantly less likely to fail medical management than larger collections (0/33â¯vs 6/11; p < 0.0001).DISCUSSION:
Not all post appendicectomy IACs require drainage. The relationship between collection volume and need for drainage is more closely assessed using a volume calculation rather than a single dimension measurement, particularly when adjusted for weight of the child. A cut off of 2â¯ml/kg appears to be a good objective measure for intervention and provides a communication tool for discussion amongst the multidisciplinary team. Prospectively collected multicentre data on this subject would be timely. LEVEL OF EVIDENCE III.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Apendicitis
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Child
/
Humans
Idioma:
En
Revista:
J Pediatr Surg
Año:
2022
Tipo del documento:
Article
País de afiliación:
Reino Unido