ERAT for the Treatment of Peri-appendiceal Abscess

Abstract

FigureIntroduction: Endoscopic retrograde appendicitis therapy (ERAT) was proposed as a therapeutic method for the acute uncomplicated appendicitis in 2012. This study aims to describe the effects of ERAT in the treatment of peri-appendiceal abscess. Methods: The study reviewed 3 patients with peri-appendiceal abscess who received ERAT at one tertiary hospitals in 2014. ERAT was performed as described previously. Colonoscope attached by a transparent cap was used. After finding Gerlach's valve in the cecum, colonoscope is positioned close to the appendiceal orifice. Gerlach's valve was pushed aside using the transparent cap, so that the tip of a catheter could be wedged into the appendiceal orifice. Then, a 0.035-inch guidewire is inserted into the appendiceal lumen over the catheter, which is subsequently inserted deep into the lumen under fluoroscopic guidance. Decompression of appendiceal lumen was achieved by suction using a 5-ml or 20ml syringe attached to the catheter. After that, a soluble contrast agent was used to fill the appendix while being monitored by fluoroscopy to check the location and shape of abscess. Then, suction of contrast agents was repeated by using the 5 ml or 20ml syringe attached to the catheter. the appendiceal lumen and the abscess was irrigated using 50-100 ml of saline. Finally, a stent (8.5Fr or 10Fr) was placed into the lumen over the guidewire for abscess decompression with the plan to retrieve the stent after one month along with repeat ERA to ensure integrate of appendiceal lumen. Results: There were 3 patients with peri-appendiceal abscess underwent ERAT. The median procedure time of ERAT was 45 minutes (40 minutes to 55 minutes). The symptoms of these patients including spontaneously abdominal pain, abdominal tenderness and rebound tenderness, fever, nausea and vomiting was relived with 3 days. The median time until resumption of diet was 1 day (12 hours to 3 days). The median time of hospitalization was 5 days (3 days to 14 days). The median follow-up period was 5 months (4months to 7months). During the follow-up, there was no complications or recurrent case. Conclusion: ERAT is an effective method to treat peri-appendiceal abscess. Multicenter prospective clinical trials are needed to confirm its utility and place in the management of periappendiceal abscess.