Symptoms Of Abscess On Appendix: Causes, Diagnosis & Treatment

Most surgeons frequently encounter appendicitis in their daily clinical practice. Acute appendicitis is inflammation of the appendix. Appendix is a small finger like hollow tube situated at the junction of small and large intestine at the right lower side of abdomen. The function of this worm like tube is not known. It is believed to be a remnant structure of the past.

Abscess in appendix is actually a complication of acute appendicitis. It usually develops in people who delay taking treatment of acute appendicitis. Appendicular abscess is collection of pus around the appendix caused due to perforation of inflamed appendix.

The pus remains surrounded to the appendix and does not leak into the peritoneum in most cases. Usually a small abscess is treated conservatively with antibiotics and intravenous fluids. A large abscess may need surgical drainage of pus.

What Causes Abscess On Appendix?

Appendicular abscess is accumulation of pus surrounding the appendix. It develops when an infected and inflamed appendix gets perforated. It is a type of complication of untreated appendicitis. In some patients the inflamed appendix can become gangrenous. In such situation the intestine and omentum coils around the appendix to form an appendicular mass.

These mass has collection of pus that ultimately builds up to become an abscess. It usually occurs when the appendix is perforated or becomes gangrenous. The collected pus does not drain into the peritoneum as the intestinal coils and omentum surrounds and support it.

Appendicular abscess usually develops on the right lower quadrant of the abdomen. Sometimes the abscess can form in the pelvic floor or at the back of caecum. Some patients who are managed conservatively with antibiotics can also develop abscess around the appendix.

Symptoms Of Abscess On Appendix

Patients suffering from abscess on the appendix usually complain of severe pain in the right iliac fossa of the abdomen.

In some cases a mass can be palpable while examining the abdomen. Patient has classical history of appendicitis few days ahead of formation of abscess.

Vomiting, high fever, loss of appetite, right lower abdominal pain, rapid pulse, tenderness and rigidity or guarding of abdomen are all suggestive of appendicitis. There may be history of constipation or diarrhea since few days.

The abdomen may become distended. There may be bladder irritation in some patients due to anatomical proximity of the two organs. This may cause frequent urination in some patients.

Diagnosis And Treatment For Abscess On Appendix

Appendicular abscess can be diagnosed on history of appendicitis, clinical symptoms and certain blood and imaging tests. Patient may be asked for certain blood tests such as CBC, ESR. The number of white blood cells is increased in the blood test due to infection. ESR is raised. An abscess is obviously seen on sonogram or CT scan of abdomen. The accurate size can also be measured with the radiological investigation.

Appendicular abscess is often treated conservatively with antibiotics and intravenous fluid. During this period patient is advised to give rest to the intestine. He is advised to avoid intake of food for a day. Since he is on intravenous fluid, the electrolytes and body fluids are well maintained. Once the patient is stable and abscess resolves, the appendix can be removed with surgery after few months.

Sometimes a large abscess may need to be drained, but there is always a risk of peritonitis associated with it. Thus after evaluating the condition and all aspect of the general health of the patient, the surgeon may take decision for open laparotomy.