[Polymicrobial sepsis and perityphlic abscess: case report and review of literature].

OBJECTIVE

To evaluate the safety and efficacy of conservative therapy of polymicrobial anaerobic sepsis and appendiceal mass.

METHODS

We report on an 18-year-old patient admitted for fever (38.8 degrees C), abdominal pain and vomiting. Leukocytosis with left shift maturation, and diarrhea were noted during hospital stay. A Fusobacterium species and Bacteroides ovatus were isolated from blood culture specimens. Radiologic examination with barium enema showed normal ileocecal region, while colonoscopy indicated terminal ileitis. Abdominal ultrasound and computed tomography showed appendiceal mass sized 6.5x5.5 cm in the right lower quadrant. The patient was treated with intravenous antibiotic therapy consisting of amoxicillin + clavulanic acid and metronidazole for 21 days. He was discharged from the hospital when control ultrasound indicated disappearance of the appendiceal mass.

CONCLUSIONS

Acute appendicitis is the most common cause of urgent surgery in children. Bacterial enteritis limited to the ileocecal region appears to be responsible for an appreciable number of unnecessary appendectomies. On the other hand, diagnostic errors in appendicitis may delay early appendectomy and result in the formation of appendiceal mass. The advent of high-resolution real-time scanners and graded compression sonography has enabled not only an accurate diagnosis of acute appendicitis but also a reliable diagnosis of other diseases of the ileocecal region. Acute terminal ileitis has similar clinical and laboratory manifestations as acute appendicitis, thus presenting a common diagnostic problem in daily practice. Perforation occurs in 20% to 30% of children with acute appendicitis. Perforation may be difficult to diagnose by sonography. The most common complications are peritonitis and intraperitoneal abscesses. The management of appendiceal mass remains controversial, such as interval appendectomy after nonoperative treatment.

CONCLUSIONS

Successful conservative treatment for polymicrobial anaerobic sepsis and appendiceal mass in an 18-year-old patient is described. The case report is followed by review of the literature on the appendiceal mass management.