Medical treatment of postappendectomy intraperitoneal abscesses in children.

Treatment of postappendectomy intraperitoneal abscesses is classically surgical (drainage). We report a retrospective study (1988 to 1991) of our experience in providing exclusively medical treatment for 11 such isolated abscesses in children. The abscess was detected 7 times within the 10 days following appendectomy. Ultrasonography localized the abscess 7 times in the right iliac fossa and 4 times in Douglas' pouch. In 4 cases it was larger than 5 cm in diameter. Parenteral antibiotic therapy associated ticarcillin and clavulanic acid 6 times and piperacillin, tobramycin and metronidazole 5 times. Drug efficacy was evaluated by clinical signs (fever, pain, ileus) and ultrasonography. In one case, an associated ileus led to reoperation at day 4 of treatment. In the other 10 cases, clinical signs disappeared during the first week of treatment. At day 7, parenteral was replaced by oral antibiotic therapy (metronidazole 7 times, amoxicillin-clavulanic acid 3 times) continued until the abscess was no longer visualized on ultrasonography (5 times at 3 weeks, 5 times at 1 month). Medical treatment of isolated postappendectomy abscesses in children would thus appear to be a logical choice in the absence of an associated ileus.