{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T05:51:51Z","timestamp":1775454711652,"version":"3.50.1"},"reference-count":90,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Post-appendectomy intra-abdominal abscess (PAA) is a common and problematic complication in children with perforated appendicitis, contributing to prolonged hospitalization, readmissions, and increased healthcare costs. Despite advances in surgical and antimicrobial management, substantial heterogeneity persists in definitions, risk stratification, and treatment strategies. This narrative review aims to synthesize current evidence regarding the pathophysiology, risk factors, diagnostic pathways, clinical impact, and therapeutic approaches to PAA in the pediatric population. PAA occurs predominantly after perforated appendicitis and reflects persistent contamination and fibrin-driven loculation within the peritoneal cavity. Established predictors include fecalith presence, higher perforation severity, and elevated inflammatory markers. Diagnosis is typically established during the second postoperative week using ultrasound as first-line imaging. Management strategies vary widely, ranging from antibiotics alone to percutaneous or surgical drainage. PAA significantly increases length of stay, need for invasive procedures, and healthcare expenditure. In conclusion, PAA remains a clinically significant complication in pediatric perforated appendicitis. Standardized definitions, validated predictive tools, and high-quality trials are urgently needed to harmonize management, optimize outcomes, and reduce variability in care.<\/jats:p>","DOI":"10.3390\/medicina62040686","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T04:10:27Z","timestamp":1775448627000},"page":"686","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-Appendectomy Intra-Abdominal Abscess in Children with Perforated Appendicitis: A Narrative Review"],"prefix":"10.3390","volume":"62","author":[{"given":"Ciprian-Ioan","family":"Borca","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Department of Pediatric Surgery and Orthopedics, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7935-4471","authenticated-orcid":false,"given":"Alexandru Cristian","family":"Cindrea","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Emergency Department, Emergency Clinical Municipal Hospital, 300254 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2375-2793","authenticated-orcid":false,"given":"Madalin-Marius","family":"Margan","sequence":"additional","affiliation":[{"name":"Discipline of Public Health, Department of Functional Sciences, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Centre for Translational Research and Systems Medicine, Faculty of Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5097-858X","authenticated-orcid":false,"given":"Roxana","family":"Margan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Discipline of Hygiene, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Center for Studies in Preventive Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2245-231X","authenticated-orcid":false,"given":"Alexandru","family":"Alexandru","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2242-7764","authenticated-orcid":false,"given":"Ovidiu Alexandru","family":"Mederle","sequence":"additional","affiliation":[{"name":"Emergency Department, Emergency Clinical Municipal Hospital, 300254 Timisoara, Romania"},{"name":"Department of Surgery, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4295-7487","authenticated-orcid":false,"given":"Vlad Laurentiu","family":"David","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopedics, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1001\/jamasurg.2024.1759","article-title":"Population-Based Intraoperative Disease Severity Criteria for Pediatric Appendicitis","volume":"159","author":"McKie","year":"2024","journal-title":"JAMA Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1001\/jamasurg.2018.2085","article-title":"Association of Intraoperative Findings with Outcomes and Resource Use in Children with Complicated Appendicitis","volume":"153","author":"Anandalwar","year":"2018","journal-title":"JAMA Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1007\/s00431-016-2756-0","article-title":"Intervention Not Always Necessary in Post-Appendectomy Abscesses in Children; Clinical Experience in a Tertiary Surgical Centre and an Overview of the Literature","volume":"175","author":"Gorter","year":"2016","journal-title":"Eur. 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