Quick Take: Risk of Appendiceal Neoplasm in Periappendicular Abscess in Patients Treated With Interval Appendectomy vs Follow-up With Magnetic Resonance Imaging 1-year Outcomes of the Peri–Appendicitis Acute Randomized Clinical Trial

Patients presenting with appendicitis are typically stratified as having either uncomplicated or complicated acute appendicitis, the latter of which may include the formation of a closed, circumscribed periappendicular abscess. While early appendectomy in the acute phase is the standard of care in the adult patient population, there is evidence to suggest that non-operative management in this setting is superior. There is also controversy surrounding the need for interval or delayed appendectomy after successful non-operative management of a periappendicular abscess. In this randomized controlled trial, 60 adult patients with periappendicular abscess diagnosed by computed tomography were randomized to either interval appendectomy or follow-up with magnetic resonance imaging after initial non-operative treatment with antibiotic therapy and abscess drainage, if needed, to compare treatment success between these two treatment strategies. On the basis of an interim analysis in April 2016, researchers found a high rate of neoplasm (17%), with all neoplasms occurring in patients older than 40 years. As such, the trial was prematurely terminated owing to ethical concerns. Two more neoplasms were diagnosed after study termination, resulting in an overall neoplasm incidence of 20%. On study termination, the overall morbidity rate of interval appendectomy was 10%. This study therefore shows that patients age 40 years or older may have a high rate of neoplasm after periappendicular abscess. While further studies are needed to replicate the findings, these results support the conduct of routine interval appendectomy following the initial non-operative management of periappendicular abscess in adults.

Click to read the study in JAMA Surgery

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