{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T14:26:53Z","timestamp":1758810413848},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T00:00:00Z","timestamp":1639785600000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This descriptive retrospective study was carried out over 3\u00a0years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi<jats:sup>2<\/jats:sup> test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The mean age was 40.51\u00a0years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients,\u00a0open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection.\u00a0The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6\u00a0months (4\u201324\u00a0weeks) and was uneventful.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12893-021-01424-8","type":"journal-article","created":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T09:02:39Z","timestamp":1639818159000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The management of appendicular abscesses in a Tunisian Tertiary Care Hospital"],"prefix":"10.1186","volume":"21","author":[{"given":"Atef","family":"Mejri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaoula","family":"Arfaoui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Ali","family":"Mseddi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Ben","family":"Slima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarra","family":"Saad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwen","family":"Yahyaoui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,12,18]]},"reference":[{"issue":"1","key":"1424_CR1","doi-asserted-by":"publisher","first-page":"228","DOI":"10.21276\/ijcmsr.2020.5.1.49","volume":"5","author":"LM Reddy","year":"2020","unstructured":"Reddy LM, Bai VR, Lakshmi VV. A study on need of emergency laparascopic appendicectomy for appendiceal masses. IJCMSR. 2020;5(1):228.","journal-title":"IJCMSR."},{"key":"1424_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1757-1626-2-1","volume":"2","author":"I Ismail","year":"2009","unstructured":"Ismail I, Iusco D, Jannaci M, Navarra GG, Grassi A, Bonomi S, et al. Prompt recognition of stump appendicitis is important to avoid serious complications: a case report. Cases J. 2009;2:1.","journal-title":"Cases J."},{"issue":"Suppl 2","key":"1424_CR3","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s12262-012-0772-5","volume":"77","author":"J Debnath","year":"2015","unstructured":"Debnath J, Kumar R, Mathur A, Sharma P, Kumar N, Shridhar N, et al. On the role of ultrasonography and ct scan in the diagnosis of acute appendicitis. Indian J Surg. 2015;77(Suppl 2):221\u20136.","journal-title":"Indian J Surg"},{"key":"1424_CR4","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.amsu.2019.10.016","volume":"48","author":"Z Demetrashvili","year":"2019","unstructured":"Demetrashvili Z, Kenchadze G, Pipia I, Khutsishvili K, Loladze D, Ekaladze E, et al. Comparison of treatment methods of appendiceal mass and abscess: a prospective cohort study. Ann Med Surg (Lond). 2019;48:48\u201352.","journal-title":"Ann Med Surg (Lond)"},{"key":"1424_CR5","doi-asserted-by":"publisher","first-page":"71","DOI":"10.5505\/tjtes.2012.07448","volume":"18","author":"B Kaya","year":"2012","unstructured":"Kaya B, Sana B, Eris C, Kutani\u015f R. Immediate appendectomy for appendiceal mass. Ulusal travma ve acil cerrahi dergisi Turkish J Trauma Emerg Surg. 2012;18:71\u20134.","journal-title":"Ulusal travma ve acil cerrahi dergisi Turkish J Trauma Emerg Surg."},{"issue":"3","key":"1424_CR6","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/j.surg.2016.04.021","volume":"160","author":"E Lietz\u00e9n","year":"2016","unstructured":"Lietz\u00e9n E, M\u00e4llinen J, Gr\u00f6nroos JM, Rautio T, Paajanen H, Nordstr\u00f6m P, et al. Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging? Surgery. 2016;160(3):789\u201395.","journal-title":"Surgery"},{"issue":"2","key":"1424_CR7","doi-asserted-by":"publisher","first-page":"406","DOI":"10.2214\/ajr.185.2.01850406","volume":"185","author":"N Pinto Leite","year":"2005","unstructured":"Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005;185(2):406\u201317.","journal-title":"AJR Am J Roentgenol"},{"key":"1424_CR8","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1016\/S0140-6736(11)60410-8","volume":"377","author":"C Vons","year":"2011","unstructured":"Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet. 2011;377:1573\u20139.","journal-title":"Lancet"},{"issue":"8","key":"1424_CR9","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1002\/bjs.9835","volume":"102","author":"JJ Atema","year":"2015","unstructured":"Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979\u201390.","journal-title":"Br J Surg"},{"key":"1424_CR10","doi-asserted-by":"crossref","unstructured":"Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery. 2010; 147(6): 818\u201329.","DOI":"10.1016\/j.surg.2009.11.013"},{"key":"1424_CR11","doi-asserted-by":"crossref","unstructured":"Okune EB, Marek G, Jarosaw K. Management of appendiceal mass in children and adults: our experience. Internet J Surg. 2006 (cited 2021 Jan 24);9(2).","DOI":"10.5580\/1498"},{"issue":"2","key":"1424_CR12","doi-asserted-by":"publisher","first-page":"136","DOI":"10.4103\/0972-9941.78345","volume":"7","author":"VV Shindholimath","year":"2011","unstructured":"Shindholimath VV, Thinakaran K, Rao TN, Veerappa YV. Laparoscopic management of appendicular mass. J Minimal Access Surg. 2011;7(2):136.","journal-title":"J Minimal Access Surg"},{"issue":"2","key":"1424_CR13","first-page":"79","volume":"10","author":"R Surana","year":"1995","unstructured":"Surana R, Puri P. Appendiceal mass in children. Pediatr Surg Int. 1995;10(2):79\u201381.","journal-title":"Pediatr Surg Int"},{"issue":"1","key":"1424_CR14","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.ijsu.2010.10.006","volume":"9","author":"MA Bahram","year":"2011","unstructured":"Bahram MA. Evaluation of early surgical management of complicated appendicitis by appendicular mass. Int J Surg. 2011;9(1):101\u20133.","journal-title":"Int J Surg"},{"issue":"6","key":"1424_CR15","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1053\/jpsu.2002.32895","volume":"37","author":"M Samuel","year":"2002","unstructured":"Samuel M, Hosie G, Holmes K. Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. J Pediatr Surg. 2002;37(6):882\u20136.","journal-title":"J Pediatr Surg"},{"issue":"12","key":"1424_CR16","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1007\/s00464-001-9232-1","volume":"16","author":"PSP Senapathi","year":"2002","unstructured":"Senapathi PSP, Bhattacharya D, Ammori BJ. Early laparoscopic appendectomy for appendicular mass. Surg Endosc. 2002;16(12):1783\u20135.","journal-title":"Surg Endosc"},{"key":"1424_CR17","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.ijscr.2018.07.031","volume":"50","author":"A Elkbuli","year":"2018","unstructured":"Elkbuli A, Diaz B, Polcz V, Hai S, McKenney M, Boneva D. Operative versus non-operative therapy for acute phlegmon of the appendix: is it safer? A case report and review of the literature. Int J Surg Case Rep. 2018;50:75\u20139.","journal-title":"Int J Surg Case Rep"},{"issue":"1","key":"1424_CR18","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1007\/s00464-016-4957-z","volume":"31","author":"P Horvath","year":"2017","unstructured":"Horvath P, Lange J, Bachmann R, Struller F, K\u00f6nigsrainer A, Zdichavsky M. Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surg Endosc. 2017;31(1):199\u2013205.","journal-title":"Surg Endosc"},{"issue":"6","key":"1424_CR19","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1016\/j.amjsurg.2017.07.039","volume":"214","author":"TS Helling","year":"2017","unstructured":"Helling TS, Soltys DF, Seals S. Operative versus non-operative management in the care of patients with complicated appendicitis. Am J Surg. 2017;214(6):1195\u2013200.","journal-title":"Am J Surg"},{"issue":"4","key":"1424_CR20","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1007\/s13304-020-00749-y","volume":"72","author":"D Tartaglia","year":"2020","unstructured":"Tartaglia D, Fatucchi LM, Mazzoni A, Miccoli M, Piccini L, Pucciarelli M, et al. Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients. Updates Surg. 2020;72(4):1175\u201380.","journal-title":"Updates Surg"},{"issue":"7","key":"1424_CR21","doi-asserted-by":"publisher","first-page":"2072","DOI":"10.1007\/s00464-019-06746-6","volume":"33","author":"GS Quah","year":"2019","unstructured":"Quah GS, Eslick GD, Cox MR. Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis. Surg Endosc. 2019;33(7):2072\u201382.","journal-title":"Surg Endosc"},{"issue":"2","key":"1424_CR22","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1007\/s00268-008-9843-y","volume":"33","author":"G Katsuno","year":"2009","unstructured":"Katsuno G, Nagakari K, Yoshikawa S, Sugiyama K, Fukunaga M. Laparoscopic appendectomy for complicated appendicitis: a comparison with open appendectomy. World J Surg. 2009;33(2):208\u201314.","journal-title":"World J Surg"},{"issue":"12","key":"1424_CR23","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1007\/s00268-002-6457-7","volume":"26","author":"JBY So","year":"2002","unstructured":"So JBY, Chiong E-C, Chiong E, Cheah W-K, Lomanto D, Goh P, et al. Laparoscopic appendectomy for perforated appendicitis. World J Surg. 2002;26(12):1485\u20138.","journal-title":"World J Surg"},{"issue":"4","key":"1424_CR24","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1089\/sur.2010.079","volume":"12","author":"PL Wagner","year":"2011","unstructured":"Wagner PL, Eachempati SR, Aronova A, Hydo LJ, Pieracci FM, Bartholdi M, et al. Contemporary predictors of conversion from laparoscopic to open appendectomy. Surg Infect (Larchmt). 2011;12(4):261\u20136.","journal-title":"Surg Infect (Larchmt)"},{"key":"1424_CR25","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ijsu.2015.06.089","volume":"21","author":"N Antonacci","year":"2015","unstructured":"Antonacci N, Ricci C, Taffurelli G, Monari F, Del Governatore M, Caira A, et al. Laparoscopic appendectomy: which factors are predictors of conversion? A high-volume prospective cohort study. Int J Surg. 2015;21:103\u20137.","journal-title":"Int J Surg"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01424-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-021-01424-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01424-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T21:18:10Z","timestamp":1639862290000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-021-01424-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1424"],"URL":"https:\/\/doi.org\/10.1186\/s12893-021-01424-8","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"5 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"An ethical approval was obtained from the Rabta Hospital Medical Ethics Committee. written informed consent obtained from patients and from legally authorized representative of minors. We confirm that all methods were performed by the 1975 Declaration of Helsinki's ethical guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"427"}}