A patient 3 days post appendicectomy for gangrenous appendicitis develops a fever of 38.9°C, right lower quadrant pain, and a tender mass in the RIF. CT scan shows a 5 cm pericaecal collection with no free perforation. The preferred management is:

• A Re-exploration and surgical drainage
• B Intravenous antibiotics alone
• C Defunctioning ileostomy to protect the area
• D CT-guided percutaneous drainage and antibiotics ✓

Explanation

Post-appendicectomy pericaecal/pelvic abscess in the absence of generalised peritonitis is best managed by CT-guided percutaneous drainage combined with systemic antibiotics. This minimally invasive approach avoids the morbidity of re-exploration in recently operated bowel and achieves successful drainage in > 85% of cases. IV antibiotics alone without drainage are insufficient for a 5 cm collection. Surgical re-exploration is reserved for failed percutaneous drainage or clinical deterioration.

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.