IMAGE-GUIDED DRAINAGE AND ANTIBIOTIC THERAPY AS CONSERVATIVE MANAGEMENT IN COMPLICATED APPENDICITIS: TWO CASE REPORTS danielbarocio03@gmail.com

PE070

IMAGE-GUIDED DRAINAGE AND ANTIBIOTIC THERAPY AS CONSERVATIVE MANAGEMENT IN COMPLICATED APPENDICITIS: TWO CASE REPORTS

9

Pamela Lopez pamlopez@gmail.com ISSSTE Surgery Hermosillo Mexico

 

 

 

Mexico

Poster Exhibition only

Acute appendicitis is among the most frequent surgical emergencies, with a global incidence of approximately 100 cases per 100,000 people annually. While most cases are uncomplicated, 20–30% evolve into complicated appendicitis (perforation, gangrene, abscess, or generalized peritonitis), significantly increasing morbidity and mortality.

Case 1: A 28-year-old male with a 10-day history of diffuse lower abdominal pain, asthenia, diarrhea, and fever. Contrast-enhanced CT showed perforated appendicitis with phlegmon and a pericecal abscess containing gas (80 × 80 × 57 mm; 190 cc). Case 2: A 37-year-old male, without comorbidities, presented after two weeks of abdominal pain, nausea, vomiting, and fever. Non-contrast CT revealed a 173 cc hypogastric abscess with air-fluid level, suggestive of complicated appendicitis.

Both patients were hemodynamically stable, afebrile, and without peritoneal signs upon admission. Conservative treatment was initiated with image-guided percutaneous drainage (146 cc in Case 1; 129 cc in Case 2) and broad-spectrum antibiotics. Hospitalization lasted three days, with discharge home and outpatient follow-up. Control CT scans at two weeks showed no residual collections. Drains were removed without complications.

Conservative management of complicated appendicitis with image-guided drainage and antibiotic therapy is a safe and effective alternative for selected patients with well-defined abscesses. Supported by the Jerusalem Guidelines, this approach may prevent urgent surgery, reduce complications, and allow for delayed or omitted appendectomy. Treatment decisions should be individualized, considering clinical stability, imaging availability, and surgical expertise.