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)
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
15
Original Article
SMJ
1 out of 15 patients (7%) who had initially successful
treatment via combining antibiotics and CT-guided
drainage for a perityphlitic appendiceal abscess had
recurrent appendicitis. Similar to our study, the risk of
recurrent appendicitis was very low as 1 out of 44 patients
(2.3%) in the percutaneous drainage group and 3 out
of 57 (5.3%) in the antibiotics-alone group, but with no
statistical signicance (P value, 0.438).
e purpose of our study was to retrospectively
compare the outcomes of treatment in patients with
periappendiceal abscess or phlegmon who underwent:
percutaneous drainage, antibiotics therapy alone, or
emergency surgery. Until recently, studies have mostly
compared the treatment outcomes between two groups:
immediate surgery and non-surgical treatment.
3,7,12
ose
studies revealed a better outcome for the conservatively
treated group, with a lower incidence of complications.
Kim JK, et al.
3
compared the treatment outcomes between
emergency operation and antibiotics groups, with or
without percutaneous drainage. ey showed a good
outcome (91.7%) for the conservatively treated group.
e only prospective, randomized, controlled trial study
that compared the outcomes between percutaneous
drainage group and antibiotics-only group was by Zerem
et al.,
13
which included periappendiceal abscesses equal
to or >3 cm in diameter. ose researchers concluded
that percutaneous drainage with antibiotics treatment
was more ecient than antibiotics alone because an
appendectomy was less performed in the combined
antibiotics and percutaneous drainage group than in
the antibiotics-alone group.
In contrast to our study, aer adjusting the confounding
variables (i.e., abscess grade, location, phlegmon, extraluminal
air/ appendicolith, and the length of stay), we found that
antibiotics treatment alone was signicantly associated
with a more successful outcome, with an OR of 9.882
(95% CI 1.162-84.066; P value 0.036), as compared with
the percutaneous drainage group. But surgery showed
no statistical dierence to percutaneous drainage, given
its OR of 4.529 (95% CI 0.521-39.386; P value 0.171). As
compared the successful outcomes among the three groups,
antibiotics treatment alone had a successful outcome of
48.7% (56 out of 115 patients), while the percutaneous
drainage group had a successful outcome of 32.2% (37 out
of 115 patients), and the surgery group had a successful
outcome of 19.1% (22 out of 115 patients). Our result is
dierent from that of Zerem et al.
13
because we included
patients who were diagnosed as phlegmon in 21 out of
57 patients (36.8%) in the antibiotics-alone group, but
none of the patients were diagnosed as phlegmon in the
percutaneous drainage group. Furthermore, patients
with varying sizes of abscesses were included in our
study. We found that the abscess size was largest in the
percutaneous drainage group (median size of 6.0 cm.)
as compare to the antibiotics-alone and surgical groups
which (median size of 3.7 cm. and 3.6 cm. respectively)
with a statistically signicant dierence (P value <0.001).
It means that if the abscess is large (equal to or >6 cm),
the clinician tends to choose percutaneous drainage as
the treatment option rather than giving antibiotic alone
or surgery.
Abscess size and grade are according to each other.
Table 2 shows that a Grade 1 abscess (equal or <3 cm.)
was found least frequently in the percutaneous drainage
group, as compared to the other two groups, with a
statistical dierence. It represents the clinicians’ preferring
antibiotic or surgical treatment in cases of small sized
abscess. In contrast to a Grade 3 abscess (a large abscess
or multiple locations) which was signicantly found
much more in the percutaneous drainage group than in
the antibiotics-alone group. It implies that the clinicians
tend to consult percutaneous drainage in patients with
large sized abscess. Because antibiotics therapy alone may
not be eective to get rid of those abscesses and surgical
technique may be more dicult in multiple abscesses
leading to post-operative recurrence. For a Grade 2
abscess (>3 cm. but localize), which was found equally
in every group, without signicant dierences. So, the
choice of treatment in Grade 2 abscess should depend
on clinical judgement either percutaneous drainage,
antibiotic treatment or surgery.
e study by Zerem et al.
13
found that the length of
hospital stay was signicantly shorter in the percutaneous
drainage group. But we found longer hospital stay in
the percutaneous drainage group (a median of 10 days)
than in the antibiotics group (a median of 6 days), with a
P value of 0.008. is was due to the fact that some patients
with post-percutaneous drainage were hospitalized until
no drainage output or imaging follow-up showed abscess
resolution, then the drainage catheters were removed
before they were discharged.
e limitations in our study are that it’s retrospective
and has a single-center design. e patients’ sample
size in each group was rather small. Our result which
indicated that antibiotics treatment alone was signicantly
associated with more successful outcome as compared
with percutaneous drainage had an OR of 9.882 and very
wide range ofcondence interval (95% CI 1.162-84.066).
Further research with more sample size is needed to make
the results more reliable. Lastly, some of the patients had
an incomplete clinical-data record, and approximately
50% of them did not have imaging follow-up.