Factors that predict abscess formation during conservative management of appendicular mass in children in Baghdad Medical City

Abstract

Background: Acute appendicitis is the most common surgical emergency in children, with appendicular mass being a common complication in improperly treated cases. Aim: This study aimed to identify factors contributing to abscess formation during the conservative management of appendicular mass. Methods: A prospective study was conducted on 55 children younger than 14 years with appendicular mass managed at Baghdad Children Welfare Hospital. Clinical factors including age, gender, symptom duration, nausea/vomiting, diarrhea, fever, mass size, appendicolith presence on ultrasonography, CRP titer, total WBC count, bandemia, and antibiotic regimen were evaluated. Patients who developed abscesses were treated surgically or medically. Results: The mean age of patients was 8.94±2.86 years, with males comprising 60%. Abdominal pain duration averaged 3.64±1.6 days. Nausea/vomiting occurred in 87.27%, diarrhea in 18.18%, and fever in 12.73% of cases. Elevated CRP levels (mean: 68.53±62.34 mg/dl) and leukocytosis (76.36%) were noted. Appendicolith was present in 10.91%, and the mean mass size was 18.69±14.94 cm². Antibiotic regimens primarily included vancomycin, amikacin, and metronidazole (63.64%). Abscess formation occurred in 23.64% of patients, with 46.15% of these requiring surgical intervention for abscesses >50 ml. Conclusion: Factors predictive of abscess formation include fever, diarrhea, WBC count >15×10³/ml, bandemia > 10%, CRP > 70 mg/dl, appendicolith presence, and mass size >20 cm². Effective antibiotic regimens targeting gram-negative and anaerobic organisms are crucial. Drainage decisions depend on clinical status and abscess size, with interventions required for abscesses >50 ml. Early identification of risk factors can guide therapeutic adjustments to prevent complications.