Clinical significance of appendicoliths in conservative treatment of acute complicated appendicitis patients with peri-appendiceal abscess: a single-center retrospective study

Background:This study aimed to analyze the clinical data of patients who received conservative treatment for acute complicated appendicitis with peri-appendiceal abscess, identify factors influencing the success rate, and improve treatment strategies.Methods:The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess who received conservative treatment at the Department of Emergency Surgery, Zhongshan Hospital, Fudan University, from January 2016 to March 2023, were retrospectively analyzed.Results:A total of 80 patients were included in our study. Patients were divided into two groups based on the outcomes of ultrasound-guided drainage: The Drainage group (n=28) and the Antibiotic group (n=52). The baseline characteristics of the two groups were comparable. In the Antibiotic group, the surgery rate was 30.4% for patients with an appendicolith and 6.9% for those without. In the Drainage group, the surgery rate was 33.3% for patients with an appendicolith and 27.3% for those without. The presence of an appendicolith significantly correlated with the need for surgery in the Antibiotic group (P=0.026), but not in the Drainage group (P=0.771). For patients who underwent surgery, the incidence of surgical site infections did not differ significantly (P=0.656), and the median length of postoperative hospital stay was similar between the groups (4.0 days vs. 3.0 days, P=0.337).Conclusion:The presence of an appendicolith is a risk factor for the failure of antibiotic therapy alone in acute complicated appendicitis patients with peri-appendiceal abscess. However, it does not affect the surgical rate in those who underwent successful drainage.