Clinical significance of appendicoliths in conservative treatment of acute complicated appendicitis patients with peri-appendiceal abscess: A single-center retrospective study

Abstract

Background The optimal conservative treatment options for acute complicated appendicitis with peri-appendiceal abscess remain controversial. This study aimed to analyze the clinical data of patients who received conservative treatment for this condition, identify factors influencing the success rate, and improve treatment strategies. Methods The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess who received conservative treatment at the Department of Emergency Surgery, Zhongshan Hospital, Fudan University, from January 2016 to March 2023, were retrospectively analyzed. Patients were divided into two groups based on the outcomes of ultrasound-guided drainage, and their clinicopathological and surgery-related features were compared. Results A total of 80 patients were included in our study. Patients were divided into two groups based on the outcomes of ultrasound-guided drainage: The Drainage group (n = 28) and Antibiotic group (n = 52). The baseline characteristics of the two groups were comparable. The mean abscess size was 7.0 cm in the Drainage group and 4.5 cm in the Antibiotic group. Additionally, 21.4% of patients in the Drainage group have an appendicolith, compared to 44.2% in the Antibiotic group. Eight patients in the Drainage group and nine in the Antibiotic group underwent surgery. In the Antibiotic group, the surgery rate was 30.4% for patients with an appendicolith and 6.9% for those without. In the Drainage group, the surgery rate was 33.3% for patients with an appendicolith and 27.3% for those without. The presence of an appendicolith significantly correlated with the need for surgery in the Antibiotic group (P = 0.026), but not in the Drainage group (P = 0.771). For patients who underwent surgery, the incidence of surgical site infections did not differ significantly (P = 0.656), and the median length of postoperative hospital stay was similar between the groups (4.0 days vs. 3.0 days, P = 0.337). Conclusion The presence of an appendicolith is a risk factor for the failure of antibiotic therapy alone in acute complicated appendicitis patients with peri-appendiceal abscess. However, it does not affect the surgical rate in those who underwent successful drainage.