The Impact of Postoperative Abscess Formation in Perforated Appendicitis

ABSTRACT Background The coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis. Methods We performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected. Results Of the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively. Conclusions The COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.

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The impact of intraoperative culture on treatment and outcome in children with perforated appendicitis

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(99)90368-8 ◽

1999 ◽

Vol 34 (5) ◽

pp. 749-753 ◽

Cited By ~ 45

Author(s):

Evan R. Kokoska ◽

Mark L. Silen ◽

Thomas F. Tracy ◽

Patrick A. Dillon ◽

Donald J. Kennedy ◽

...

Keyword(s):

Perforated Appendicitis ◽

The Impact

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Lower Extremity Abscess Formation in Premature Infants due to Routine Infant Vaccinations

Case Reports in Pediatrics ◽

10.1155/2017/3290184 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Yuhang Sun ◽

Surya N. Mundluru ◽

Alice Chu

Keyword(s):

Magnetic Resonance Imaging ◽

Premature Infants ◽

Medical Records ◽

Surgical Intervention ◽

Abscess Formation ◽

Imaging Findings ◽

Resonance Imaging ◽

First Case ◽

The Impact ◽

Routine Infant

Since the introduction of vaccines, the impact of vaccinations has been immeasurable. Under the current immunization guidelines, infants receive the first of their routine infant vaccinations at 2 months of age. While the benefits of routine infant vaccinations in premature infants have been demonstrated, there is relatively little data on the dosing of these vaccines in premature infants. The medical records of two premature infants who developed intramuscular abscesses after receiving their routine infant vaccinations were reviewed. Both patients developed pain in the area of the injection after receiving their vaccinations. Magnetic resonance imaging findings confirmed the formation of an abscess. No other causes of abscess formation were observed. Both patients required surgical intervention and were treated with a course of antibiotics. To our knowledge, this is the first case report to suggest routine vaccinations as a potential cause of abscess formation in premature infants.

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Impact of the SARS-CoV-2 pandemic on emergency surgery services—a multi-national survey among WSES members

World Journal of Emergency Surgery ◽

10.1186/s13017-020-00341-0 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Martin Reichert ◽

◽

Massimo Sartelli ◽

Markus A. Weigand ◽

Christoph Doppstadt ◽

...

Keyword(s):

Emergency Surgery ◽

Elective Surgery ◽

Perforated Appendicitis ◽

Surgical Patients ◽

Patient Treatment ◽

Surgical Patient ◽

Structural Problems ◽

Number Of Patients ◽

Time To Diagnosis ◽

The Impact

Abstract Background The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now. Methods A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients. Results Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients. Conclusions The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.

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Preoperative antipseudomonal coverage reduces postoperative abscess formation in perforated appendicitis: A 10-year experience

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2009.06.040 ◽

2009 ◽

Vol 209 (3) ◽

pp. S21-S22

Author(s):

Robert A. Brenes ◽

Shohan Shetty ◽

Jose M. Pimiento ◽

Tung Ho ◽

Peter Ferrante ◽

...

Keyword(s):

Perforated Appendicitis ◽

Abscess Formation

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Abscess Formation in a Right Inguinal Hernia Sac after Appendectomy for Perforated Appendicitis in a Ten-year-old Girl—A Case Report—

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.79.1111 ◽

2018 ◽

Vol 79 (5) ◽

pp. 1111-1116

Author(s):

Hiroki NAKAMOTO ◽

Ryouji YOKOYAMA ◽

Makoto NISHIKAWA ◽

Akinobu TAKETOMI

Keyword(s):

Case Report ◽

Inguinal Hernia ◽

Perforated Appendicitis ◽

Abscess Formation ◽

Hernia Sac

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A Four-Year Hospital Journey for a Lost and Migrating Appendicolith

Case Reports in Surgery ◽

10.1155/2015/832434 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Daniel Schraffl ◽

Herman Frima ◽

P. Villiger

Keyword(s):

Rare Case ◽

Perforated Appendicitis ◽

Flank Pain ◽

Abscess Formation ◽

Stone Removal

We report a rare case of recurrent abscess formation, including being at a retroperitoneal site, due to a lost and migrating appendicolith. Over a four-year period and following an episode of perforated appendicitis, an otherwise healthy young man underwent two operations for abscess formation with eventual stone removal. Appendicoliths can pose a challenge during the diagnostic and therapeutic journey, and adequate attempts at removal need to be made to prevent avoidable complications. In patients suffering from recurrent flank pain and abscesses after appendectomy, the possibility of a lost or overlooked appendicolith should be considered.

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Role of Drains in Laparoscopic Appendectomy for Complicated Appendicitis at a Busy County Hospital

The American Surgeon ◽

10.1177/000313481408001036 ◽

2014 ◽

Vol 80 (10) ◽

pp. 1078-1081 ◽

Cited By ~ 5

Author(s):

Andrea M. Pakula ◽

Ruby Skinner ◽

Amber Jones ◽

Ray Chung ◽

Maureen Martin

Keyword(s):

Laparoscopic Appendectomy ◽

Perforated Appendicitis ◽

Pelvic Abscess ◽

Abscess Formation ◽

White Blood Count ◽

Patient Demographics ◽

Gangrenous Appendicitis ◽

Group I ◽

Drain Group ◽

Group Ii

Laparoscopic appendectomy (LA) has become the treatment of choice for acute appendicitis with equal or better outcomes than traditional open appendectomy (OA). LA in patients with a gangrenous or perforated appendicitis carries increased rate of pelvic abscess formation when compared with OA. We hypothesized routine placement of pelvic drains in gangrenous or perforated appendicitis decreases pelvic abscess formation after LA. Three hundred thirty-one patients undergoing LA between January 2007 and June 2011 were reviewed. Patients with perforated or gangrenous appendicitis were included. Group I had a Jackson-Pratt (JP) drain(s) placed and Group II had no JP drain. Data included patient demographics, emergency department laboratory values and vital signs, and computed axial tomography scan findings, intra-abdominal or pelvic abscess postoperatively, interventional radiology drainage, and length of stay. Clinic follow-up notes were reviewed. One hundred forty-eight patients were identified. Forty-three patients had placement of JP drains (Group I) and 105 patients had no JP drain (Group II). Three patients (three of 43 [6%]) in Group I developed pelvic abscess and 21 of 105 (20%) patients in Group II developed pelvic abscesses requiring subsequent drainage. This was statistically significant. Patient demographics, temperature, and mean white blood count before surgery were similar. Presurgery computed tomography (CT) with appendicolith and CT with abscess were more prevalent in Group I. The use of JP drainage in patients with perforated or gangrenous appendicitis during LA has decreased rates of pelvic abscess. This was demonstrated despite the drain group having appendicolith or abscess on preoperative CT.

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