Effectiveness of Antibiotic Treatment for Unruptured Appendiceal Abscess

The presence of an abscess in the appendix that has not ruptured can be effectively treated with antibiotics?

Hello Doctor: My father is 70 years old and has diabetes.
He was admitted to the hospital on February 12 (Monday) afternoon due to unusual abdominal pain.
A CT scan revealed abscesses in the appendix and colon, but fortunately, they had not ruptured.
Thirty cc of pus was immediately drained, and a drainage tube was inserted.
On the same day, his white blood cell count was 24,000.
After one day of antibiotic treatment, the count was rechecked and found to be 11,000.
In recent days, the doctor has advised him to eat plain rice and well-cooked vegetables, but he experiences diarrhea three to four hours after eating, which the doctor indicated is a sign of ongoing inflammation.
The pus drainage over the past three days has been 3 to 5 cc, and visually, the upper part of the tube is almost empty, while there is some accumulation at the bottom.
Is it because of the New Year that blood tests were not conducted, and they decided not to draw blood? Initially, it was said that if the white blood cell count was normal, he would be discharged on Saturday.
However, I am unclear about the current status of his condition and treatment, and I am hesitant to ask too many questions for fear of bothering the doctor.
I would greatly appreciate your clarification.
Thank you! Sincerely, Xiao Zhen, February 18, 2018.

Xiao Zhen, 30~39 year old female. Ask Date: 2018/02/18

Dr. Ke Fangxu reply Surgery

Based on your description, the patient's recovery seems to be good.
The white blood cell count has returned to normal, and there is no drainage of ascitic fluid from the drain, indicating that the patient is likely in a condition suitable for discharge.
If the patient is having normal bowel movements, there should be no need for continued hospitalization.
It would be important to inquire further as to why the patient is still hospitalized; perhaps the attending physician has other considerations.
It is the patient's right to request an explanation of their condition, and it is the physician's responsibility to provide it.
There is no need to worry about the physician's reaction.

Reply Date: 2018/02/18

More Info

The management of an unruptured appendiceal abscess, particularly in a patient with underlying conditions such as diabetes, requires careful consideration of antibiotic therapy and potential surgical intervention. In your father's case, the initial treatment involved the aspiration of the abscess and the placement of a drainage tube, which is a common approach for managing such conditions. The use of antibiotics is crucial in controlling the infection and preventing further complications.

From the information provided, your father's white blood cell (WBC) count decreased from 24,000 to 11,000 after one day of antibiotic treatment, indicating a positive response to the therapy. A reduction in WBC count is often a sign that the body is effectively fighting the infection. However, the persistence of symptoms such as abdominal pain and diarrhea after eating may suggest that inflammation is still present, and the body is reacting to the ongoing infection or irritation in the gastrointestinal tract.

The drainage of the abscess is also an important factor in the recovery process. The fact that the drainage output has decreased significantly (from 30cc to 3-5cc) is a good sign, as it suggests that the abscess is resolving. However, the presence of fluid accumulation in the drainage tube indicates that there may still be some residual infection or inflammation that needs to be addressed.

In terms of the treatment plan, it is essential to maintain open communication with the healthcare team. If there are concerns about your father's condition or the treatment plan, it is important to voice these concerns. Asking questions about the expected timeline for recovery, the significance of ongoing symptoms, and the plan for follow-up tests can help clarify the situation and alleviate anxiety.

Regarding the potential for discharge, the decision to release a patient from the hospital typically depends on several factors, including the stability of vital signs, the resolution of symptoms, and laboratory results. If the WBC count normalizes and the patient is stable, discharge may be considered. However, if there are still signs of infection or if the patient continues to experience significant symptoms, further observation and treatment may be warranted.

In summary, your father's treatment for an unruptured appendiceal abscess appears to be on the right track with the use of antibiotics and drainage. Continued monitoring of his symptoms and laboratory values will be essential in determining the next steps in his care. It is always advisable to discuss any concerns with the medical team to ensure that your father's treatment is tailored to his specific needs and circumstances.

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