A 55-year-old man presents with right iliac fossa pain for 5 days. CT shows a peri-appendicular abscess of 4 cm. He is afebrile after 48 hours of IV antibiotics. What is the MOST appropriate management of the appendiceal abscess at this time?

• A Immediate appendicectomy — risk of recurrence is unacceptably high
• B Continue antibiotics alone indefinitely without drainage or surgery
• C CT-guided percutaneous drainage of the abscess; interval appendicectomy after 6-8 weeks ✓
• D Laparotomy and right hemicolectomy to exclude malignancy

Explanation

For a well-defined peri-appendicular abscess in a clinically improving patient, the current evidence-based approach is non-operative management: CT-guided percutaneous drainage if the abscess is >3 cm and accessible, combined with IV antibiotics. Interval appendicectomy is then planned after 6-8 weeks to prevent recurrence (which occurs in up to 30% without surgery) and to exclude an underlying caecal tumour. Immediate surgery in the presence of an established abscess has higher complication rates than interval surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.